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ELECTRICAL    INJUPJES 


THEIR  CAUSATION,   PREVENTION 
AND  TREATMENT 


DESIGNED     FOR     THE     USE    OF    PRACTICAL 
ELECTRICAL    MEN 


BY 

CHARLES  A.  LAUEFER,  A.M.,  M.D. 

Medical  Director,  Relief  Department, 
Westinghouse  Electric  and  Manufacturing  Co.,  East  Pittsburgh,  Pa. 


FIRST  EDITION 
FIRST  THOUSAND 


NEW  YORK 

JOHN  WILEY  &  SONS 

London:  CHAPMAN  &  HALL,  Limited 
1912 


t 


Engineering 
Library 


^^^ 
K 


Copyright,  1912 

BY 

JOHN  WILEY  &  SONS 


SCIENTIFIC    PRESS 

ROBERT    DRUMWOND    AND    COMPANY 

BROOKLYN,    N.   Y 


PREFACE 


The  managements  of  our  American  railroads, 
and  many  industrial  establishments,  provide  for 
the  instruction  of  employees  in  first  aid,  and  in 
the  avoidance  of  perils  incident  to  their  work. 
This  movement  merits  our  most  cordial  approval ; 
preventive  clinics  likewise  are  both  philanthropic 
and  economically  profitable  to  large  employers, 
and  are  at  the  same  time  a  sure  index  to  the 
employee  himself  that  his  physical  welfare  is 
being  safeguarded. 

The  policy  of  the  Company  ^dth  which  the 
author  is  connected  provides  for  the  instruction 
of  employees  in  the  theory  and  practice  in  the  art 
of  artificial  respiration.  By  prompt  action  at 
resuscitation  many  lives  have  been  saved; 
a  number  of  the  thousand  men  I  have  instructed 
have  rendered  efficient  service  in  these  emer- 
gencies. 

Scores  of  employers  in  the  electrical  field  have 
sent  inquiries,  and  instruction  cards  have  been 
sent  out  to  power  plants  and  central  stations 
far   and   near.     Great   interest   has   been   man- 

257831 


IV  PREFACE 

ifested  by  electrical  men  everyrv^here,  in  the 
way  of  precautions  leading  to  prevention  of 
these  accidents,  and  particularly  in  the  way  of 
preparing  themselves  so  as  to  render  effectual 
aid  to  comrades  in  electrical  shock. 

This  intelligent  interest  among  employers 
and  employees,  in  the  mutual  efforts  to  avoid 
these  tragic  electrical  deaths,  augurs  well  for 
the  eventual  industrial  triumph  of  electricity, 
as  a  human  agency  fully  as  safe  as  gas  or  water. 

With  the  sincerest  appreciation  of  the  con- 
tinual courtesies  accorded  me  by  electrical  men 
in  these  inquiries,  these  pages  are  submitted  to  a 
generous  public. 

Charles  A .  Lauffer,  M.D. 

WiLKINSBURG  (PITTSBURGH),  Pa., 

April  1,  1912. 


CONTENTS 


Electrical   Injuries  :  page 

Causation  of  Flash  Injuries 1 

Prevention  of  Electrical  Flashes 3 

Pathology  of  Flash  Injuries 4 

Symptoms  of  Flashed  Eyes 5 

Treatment  of  Flashed  Eyes 6 

Symptoms  of  Flashed  Skin 8 

Treatment  of  Flash  Burns  of  the  Skin 9 

Symptoms  of  Flashes  from  High  Voltages.  11 

Treatment  of  High  Voltage  Flashes 11 

Contact  Injuries 11 

Factors    in    Causation  of  Contact  Burns, 

and  Serious  Shock 12 

Criminal  Electrocutions 19 

Theories  of  Electrical  Shock 22 

Breaking  the  Contact 24 

Resuscitation  by  Artificial  Respiration 26 

Rules  Fon  Artificial  Respiration 27 

Supplemental  Efforts 29 

Advantages  of  the  Prone  Pressure  Method.  31 

Symptoms  of  Contact  Burns 33 

Treatment  of  Contact  Burns 34 

Forethought 35 

Are  Too  Many  Deaths  Attributed  to  Elec- 
tricity?    36 

V 


vi  CONTENTS 

PAGE 

Minor  Surgery  and  First  Aid 40 

Classification  of  Wounds 40 

Hemorrhage  from  Wounds 41 

Burns,  Fractures 42 

Infections 44 

Bacteria  Defined > 44 

Wound  Infection 45 

Infectious  Diseases 46 

The  Effects  of  Occupation  on  Health..  49 

Exercise 51 

Food 58 

Fatigue 63 

Sleep 65 

Questions  on  Electrical  Injuries 69 

Questions  on  Minor  Surgery 73 

Questions  on  Infection 74 

Questions  on  Health  and  Occupation 75 


ELECTRICAL  INJURIES' 


The  usual  injuries  encountered  in  the  industrial 
application  of  electricity  are  due  to  exposure 
to  either  flashes  or  actual  contact. 

Causation  of  Flash  Injuries 

Flashes,  or  arcs,  occur  upon  breaking  or 
momentarily  short-circuiting  direct  and  alternat- 
ing current,  as,  for  example,  where  a  switch  in  a 
heavily  loaded  circuit  is  opened  by  mistake; 
where    wires    with    deficient    insulation    become 

1  See  similar  articles  by  the  same  author  in  The  Electric 
Journal,  Vol.  VIII,  Nos.  2  and  8.  The  Medical  World, 
July,  1911.  The  Central  Station,  September,  1911;  Human 
Engineering,  Vol.  I,  No.  4. 

This  paper  was  originally  presented  before  The  Westing- 
house  Club  of  Wilkinsbiu-g  (Pittsburgh)  lecture  season 
of  1910.  From  its  nature,  it  required  the  co-operative 
efiforts  of  an  electrical  man  and  a  medical  man.  Special 
acknowledgments  are  due  Mr.  E.  R.  Spencer,  Assistant 
Editor  of  The  Electric  Journal,  for  assistance  rendered; 
also  to  J.  W.  ElHott  and  F.  S.  Peterkin  for  their  comments 


2  ELECTRICAL  INJURIES 

crossed;  or  where  a  workman  at  a  switchboard 
allows  his  screwdriver  to  slip,  causing  a  short 
circuit.  There  are  a  score  of  waj's  that  will 
cause  a  sheet  of  flame  to  issue  forth,  surprising 
even  the  experienced. 

Such  is  the  origin  of  the  mild  flashes  ordinarily 
observed  and  readily  amenable  to  treatment; 
then  there  are  the  severe  burns  due  to  flashes 
from  high  voltage  conductors. 

With  a  voltage  much  in  excess  of  15,000,  a 
man  seldom  makes  contact  ^\^th  the  conductor, 
for  the  voltage  jumps  over  to  his  fingers,  flexing 
them  and  making  it  impossible  to  make  contact, 
unless  he  is  throwTi  upon  it.  It  takes  a  man  a 
percepti])le  interval  of  time  to  approach  the 
conductor,   but  the   discharge  is  instantaneous. 

The  flexor  muscles  are  so  much  stronger  than 
the  extensors,  that  the  man  is  rolled  up  and 
violently  precipitated.  The  discharge  that 
bridges  the  interval  between  the  circuit  and  its 
victim  may  cause  extensive  surface  burns,  and 
to  the  extent  that  it  spends  its  force  on  the  sur- 
face, there  is  diminished  liabihty  of  serious 
electrical  shock. 

and  constructive  criticisms;  and  to  other  electrical  men 
for  their  suggestions  and  helpful  criticisms. 

This  work  is  as  yet  fragmentarj^;  it  is  in  the  constructive 
stage;  suggestions  and  comments,  by  way  of  addition 
or  by  way  of  subtraction,  are  invited  by  the  author  from 
all  interested  in  this  endeavor  to  outUne  the  essential 
facts  of  electrical  injuries, 


PREVENTION  OF  ELECTRICAL  FLASHES     3 

The  man  approaching  the  high  voltage  con- 
ductor sinks  as  if  shot  when  the  discharge  hits 
him;  although  the  conditions  may  be  such  that 
he  vnW  receive  a  heavy  current,  the  discharge 
may,  more  fortunately,  carry  ^vith  it  only  a 
small  current,  yet  enough  to  flex  his  arm  and  leg 
muscles  violently,  and  cause  him  to  fall  "  all 
over  himself."  Such  precipitation  assists  in 
extricating  him  from  what  might  be  a  dangerous 
contact.  In  case  of  low  voltage,  if  the  hand 
grasps  the  conductor,  the  excessive  electrical 
stimulation  of  his  muscles  causes  his  grip  to 
tighten.  His  fingers  flex  tetanically.  If  un- 
assisted, he  is  often  unable  to  release  his  hold. 

Prevention  of  Electrical  Flashes 

Careful  attention  in  handling  switches  and 
plugs  is  imperative.  Circuits  should  be  open 
whenever  practicable  during  tests  and  in  repair 
work,  and  danger  signs  erected,  as  well  as  isolat- 
ing the  test  by  means  of  ropes.  In  the  repairing 
of  transmission  lines  and  transformers  connected 
thereto,  the  lines  should  be  thoroughly  grounded 
at  the  point  of  repair  on  any  side  from  which 
power  might  be  accidentally  thrown  on.  Atten- 
tion to  such  details  as  every  electrical  man  knows, 
but  sometimes  ignores,  will  do  much  to  minimize 
the  number  of  these  injuries.  With  sleeves 
rolled  up  to  the  elbows,   and  the  face  near  a 


4  ELECTRICAL  INJURIES 

switch  when  it  is  opened  on  a  circuit  carrying  a 
heavy  load,  the  exposure  to  flash  burns  is  unnec- 
essarily increased. 

Great  caution  should  be  observed  in  approach- 
ing live  high  voltage  conductors,  and  a  safe 
distance  maintained.  The  high  voltage  has 
even  been  known  to  jump  some  distance  from 
s^\atchboards,  envelop  a  man  in  its  flaming 
discharge,  seriously  burn  him,  and  violently 
throw  him  down.  High  voltage  should  never 
be  disregarded  under  any  circumstances.  It 
should  be  respected. 

While  the  arcing  distances  for  different  voltages 
are  given  in  every  standard  electrical  hand- 
book, there  are  surges  in  the  high  voltage,  and 
from  this  abnormal  voltage  there  may  be  an 
arcing  to  a  greater  distance  than  is  ordinarily 
anticipated.  The  air  resistance  once  broken 
down,  the  flaming  arc  may  carry  with  it  con- 
siderable current  to  the  man  who  has  ventured 
too  near. 

The  Fire  Underwriters  have  formulated  rules 
covering  the  property  hazard;  the  life  hazard 
surely  demands  more  adequate  consideration  from 
electrical  experts. 

Pathology  of  Flash  Injuries 

Although  electrical  flashes  are  of  momentary 
duration,  the  heat  developed  is  often  very  great. 


SYMPTOMS  OF  FLASHED  EYES  5 

This  great  heat  produces  painful  burns  on  the 
unprotected  skin  and  eyes,  the  burns  are  generally 
of  the  second  degree,  but  flashes  from  high 
voltage  may  be  of  the  third  degree,  as  well  as 
second. 

Continued  exposure  to  the  rays  of  the  electric 
arc  as  used  in  welding,  though  the  operator  may 
not  have  been  near  enough  to  feel  any  intensity 
of  heat,  may  give  rise  to  similar  burns.  Such 
burns  usually  do  not  become  apparent  until 
several  hours  after  the  exposure,  and  are  of  the 
first  and  second  degree. 

The  eyes  can  be  flashed  by  the  welding  arc 
at  a  considerable  distance.  The  welders  nec- 
essarily wear  red  and  blue  glasses  in  their  helmets 
to  protect  them  from  this  high  intensity  light. 
The  fire  of  the  flash  that  singes  the  hair  or  burns 
the  skin  is  but  one  element  in  the  production 
of  flashed  eyes;  the  effect  is  due  to  the  actinic, 
or  ultraviolet,  rays  present  in  the  electric  arc. 

Symptoms  of  Flashed  Eyes 

Eyes  which  have  been  exposed  to  electrical 
flashes  become  very  red,  due  to  the  sudden 
dilatation  and  congestion  of  the  blood  vessels 
of  the  mucous  membrane  lining  the  lids  and  in 
part  covering  the  eyeball,  known  as  the  con- 
junctiva. Such  an  inflammation  constitutes  con- 
junctivitis. The  pain  is  intense,  there  is  an 
aversion  to  light,  and  a  copious  secretion  of  tears. 


6  ELECTRICAL  INJURIES 

Often  the  eyelashes  and  eyebrows  are  singed, 
and  charred  hair,  skin  debris  and  dust  particles 
may  fill  the  eyes,  contributing  to  the  severity 
of  the  above  symptoms. 

In  the  more  severe  cases,  a  zone  of  red  may 
appear  around  the  cornea.  The  cornea  is  the 
central  transparent  area  of  the  anterior  wall 
of  the  eyeball;  under  it  lies  the  iris,  the  colored 
part  of  the  eye.  Such  a  zone  of  red  in  the  white 
of  the  eye,  near  its  junction  wdth  the  cornea, 
is  a  symptom  of  iritis,  an  evidence  of  an  inflam- 
mation of  the  iris  and  other  structures  of  the 
interior  of  the  eyeball. 

If  the  heat  of  the  flash  is  sufficient,  as  in  the 
more  severe  cases,  the  superficial  layers  of  the 
transparent  cornea  are  coagulated. 

Treatment  of  Flashed  Eyes 

The  immediate  treatment  consists  in  washing 
the  region  of  the  eye  and  eyelids  with  eye- 
water,^ then  washing  the  eye  itself.  Upon 
dropping  into  the  eyes  a  sufl&cient  quantity  of 
three   per  cent    cocaine  hydrochloride    solution, 

2  A  serviceable  formula  for  eye-water  is  as  follows: 

I^  Sodii  biboric 0.30 

Acidi  boric 0 .  15 

Alumini  sulphatis 0 .  06 

Zinci  sulphatis 0.06 

Aquae  camphorae 30 .  00 

M.     Sig. — Use  freely  as  an  eye-wash. 


TREATMENT  OF  FLASHED  EYES  7 

the  debris  may  be  mopped  out  with  clean  cotton 
wrapped  on  a  toothpick.  The  coagulated  tissue 
of  the  cornea  is  similarly  mopped  off. 

The  immediate  relief  of  pain  is  secured  by  cold 
compresses  over  the  eyes,  and  the  chief  remedy 
in  the  subsequent  treatment  is  cold  compresses — 
merely  cotton  or  a  clean  cloth  laid  on  ice,  or 
made  wet  in  ice  water,  and  changed  by  the 
patient  every  two  minutes.  The  cold  compresses 
serve  to  contract  the  dilated  blood  vessels,  and 
thus  control  the  painful  congestion.  They  can 
be  employed  for  an  hour  at  a  time,  as  the  patient 
lies  down;  not  constantly,  but  every  other  hour. 
This  enables  the  patient  to  get  some  sleep,  for 
flashed  eyes  are  most  painful  when  he  is  relaxed 
and  ready  to  sleep.  Eye-water  is  used  every 
hour.  The  eye-water  causes  no  relief  of  pain 
as  does  the  cold  compresses,  but  it  shortens  the 
term  of  disability.  In  severe  cases  adrenalin 
hydrochloride,  1  :  5000  solution,  is  used  every 
half-hour;  and  atropine  sulphate,  one  per  cent 
solution  is  used,  a  few  drops  every  four  hours 
to  control  iritis,  if  this  sjTnptom  manifests  itself. 
Also  it  may  be  necessary  to  apply  castor-oil 
every  two  hours  to  prevent  the  eyelids  and  eye- 
balls from  groT\ing  together  (s^mechial  adhesion) 
if  the  corneal  tissue  has  been  much  injured. 
In  the  milder  flashes  the  three  latter  remedies 
are  omitted,  as  the  patient  wears  smoked  glasses 
and  returns  to  work  in  two  or  three  days. 


8  ELECTRICAL  INJURIES 

It  is  conceivable  that  high  intensity  flashes 
are  capable  of  seriously  affecting  the  optic  nerves 
in  susceptible  cases,  though  such  a  case  has  never 
come  under  our  observation.  Recovery  is  prompt 
and  complete  in  practically  all  cases. 

Symptoms  of  Flashed  Skin 

Flash  burns  of  the  skin  are  usually  burns  of 
the  second  degree.  That  is  to  say,  while  destroy- 
ing the  outer  layer  of  the  skin  (the  epithelium) 
they  do  not  injure  the  inner  layer  of  the  skin 
(the  corium)  nor  the  deeper  tissues.  At  first 
these  burns  may  present  a  mere  congestion; 
the  skin  is  red,  as  from  exposure  to  the  sun,  and 
they  have  the  appearance  of  first  degree  burns, 
scarce  worth  while  dressing  and  bandaging. 
But  there  is  pain,  some  redness,  and  by  the 
second  day  huge  blebs,  or  blisters,  maj^  have 
formed.  Usually  the  hair  is  scorched;  sometimes 
the  outer  skin  is  bloTvm  off,  and  the  surface  looks 
ragged.  Under  proper  treatment  of  these  cases 
there  is  seldom  any  formation  of  pus,  and  they 
will  heal  up,  usuall}^  T\dthout  leaving  a  scar. 
We  have  treated  many  such  burns  with  the  hap- 
piest results.  We  have  treated  men  whose 
features  were  so  altered  by  burns  and  the  eyes 
so  swollen  shut,  that  their  own  mothers  would 
not  have  known  them.  To  the  uninitiated  it 
seemed   they  were  scarred  for   life,   yet "  within 


TREATMENT  OF  FLASH  BURNS  9 

two  weeks  they  were  able  to  resume  work,  and 
within  two  months  no  trace  of  their  burns  were 
discernible. 


Treatment  of  Flash  Burns  of  the  Skin 

The  immediate  treatment  of  flash  burns 
consists  in  securing  the  highest  obtainable  degree 
of  surgical  cleanliness  with  ethereal  soap  ^  appUed 
with  numerous  cotton  sponges  (using  sterilized 
absorbent  cotton  such  as  is  sold  for  medical  use) 
and  the  application  of  sterile  gauze  dressing, 
well  covered  with  Unguent ine.  We  find  this 
ointment  uniformly  reliable;  it  soothes  the  pain 
and  promotes  recovery.  A  loose  gauze  bandage 
is  apphed  and  the  part  put  at  rest. 

The  subsequent  treatment  consists  of  daily 
redressings.  When  the  blebs  are  large,  we 
scissors  them  open  freely,  but  allow  the  outer 
skin  to  remain  for  some  days,  as  it  is  in  itself  a 
splendid  protective  covering. 

*  A  good  formula  for  ethereal  soap,  that  dissolves  and 
removes  the  dirt  and  grime  and  at  the  same  time  renders 
the  area  antiseptic,  consists  of: 

Sulphuric  ether 4  oz. 

Turpentine 1  oz. 

Alcohol 3  pts. 

Surgical  soft  soap 4  lbs. 

Water,  enough  to  make 1  gal. 

If  denatured  alcohol  is  used,  the  price  of  it  is  cor- 
respondingly reduced. 


10  ELECTRICAL  INJURIES 

A  burn  must  be  washed  clean,  then  there  is 
little  liability  to  infection  with  its  pain,  the  for- 
mation of  pus,  and  the  resulting  long  term  of 
disability.  But  should  it  become  infected  and 
pus  form,  we  at  once  trim  away  the  dead  skin, 
so  as  to  allow  no  pockets  for  the  retention  of 
infection.  In  the  absence  of  infection,  that 
is,  when  the  pus-producing  bacteria  do  not  invade 
the  wound,  the  dead  skin  is  removed  within 
a  few  days,  after  the  inner  sensitive  layer  of  the 
skin  has  had  a  chance  to  harden  somewhat,  and 
to  lose  its  hypersensitiveness.  At  this  stage 
Scarlet  Salve  accelerates  recovery.  When  the 
healing  has  progressed  we  sometimes  apply 
ten  per  cent  Ichthyol  in  Petrolatum,  to  facilitate 
the  formation  of  normal  skin.  After  recovery, 
in  most  cases,  the  skin  remains  red  and  sensitive 
for  some  weeks.  We  instruct  the  patient  to 
wear  canvas  gloves  and  otherwise  protect  the 
new  skin  from  grime  and  weather,  as  it  is  prone 
to  eczema. 

The  dry,  open  method  of  treating  such  bums, 
namely,  that  of  powdering  on  stearate  of  zinc 
freely  and  exposing  them  unbandaged  to  the  air, 
is  more  or  less  successful  in  hospital  practice, 
but  not  adapted  to  ambulatory  patients,  espe- 
cially those  that  may  live  on  the  streets  and  in 
dirty  houses,  and  who  may  return  to  work  before 
complete  recovery. 


SYMPTOMS  OF  FLASHES  11 

S3miptoms  of  Flashes  from  High  Voltages 

In  contrast  to  the  usual  benign  burns  from  low 
voltage  is  the  severe  burning  from  high  voltage 
flashes,  causing  destruction  to  all  laj^ers  of  the 
skin  (third  degree  burns)  over  large  areas.  Great 
mental  excitation,  even  transient  mania,  is 
sometimes  observed  in  these  cases;  again,  on  the 
contrary,  some  patients  are  relaxed,  unconscious, 
not  breathing,  and  may  require  immediate  re- 
suscitation by  artificial  respiration. 

Treatment  of  High  Voltage  Flashes 

These  are  hospital  cases,  and  they  may  require 
much  care  to  ensure  their  recovery.  Delirium 
is  sometimes  encountered.  Where  large  areas 
are  burned  there  is  increased  danger  from  sepsis. 
When  convalescence  is  established,  skin  de- 
ficiencies are  restored  by  grafting.  In  such 
cases  the  recovery  is  slow.  Scarring  will  be  more 
or  less  extensive,  depending  on  the  depth  and 
extent  of  the  burns  and  the  infection  that  may 
be  associated. 

Contact  Injuries 

The  two  types  of  contact  injuries  are  shocks 
and  burns.  The  passage  of  an  electric  current 
through  the  human  body  may  cause  a  momentary 
unpleasantness,  the  retention  of  the  victim  within 


12  ELECTRICAL  INJURIES 

the  circuit  unable  to  release  himself,  a  suspension 
of  consciousness,  during  which  he  falls,  but 
revives  again,  or  a  suspension  of  animation, 
requiring  artificial  respiration. 

Factors  in  Causation  of  Contact  Burns,  and  Serious 
Shock 

There  is  a  mde  variety  of  external  and  individ- 
ual conditions  that  influence  the  extent  of  elec- 
trical injury,  and  there  is  an  interdependence  of 
circumstances  that  make  tabulated  results  and 
records  of  accidents  apparently  inconsistent. 
At  one  time  110  volts  are  involved,  and  there  is  a 
fatal  accident;  at  another  15,000  and  more  and 
recover}^  will  ensue.  Individual  susceptibilitj' 
is  a  large  factor,  and  the  emotions  play  no  incon- 
siderable role.  For  instance,  in  a  case  reported 
by  Jellinek,  a  lineman  died  purely  of  fright  on 
touching  a  high  voltage  line  which  was  not 
charged  at  all. 

While  fright  is  an  important  element,  it  may 
not  explain  everything;  when  an  unemotional 
healthy  man  meets  a  tragic  death,  it  is  with 
difficulty  attributed  to  his  imagination.  A  long 
distance  high-tension  transmission  line  discon- 
nected from  the  scources  of  power  may  build  up  a 
high  static  voltage,  due  to  the  action  of  the 
atmosphere,  even  in  dry  weather.  It  is  interest- 
ing to  note  that  what  appeared  to  be  a  Leyden 
jar,  or  static  condenser,  effect,  has  been  observed 


CAUSATION  OF  CONTACT  BURNS    13 

by  an  experienced  practical  electrical  man  with 
whom  the  writer  is  acquainted,  where  on  one 
occasion,  upon  going  to  the  rescue  of  a  man  who 
had  been  momentarily  rendered  unconscious  as 
the  result  of  an  electrical  shock,  he  received  a 
discharge  from  the  man's  body,  notwithstanding 
it  was  free  from  contact  with  the  circuit  which 
gave  the  shock.  This  rather  unexpected  phenom- 
enon may  possibly  be  accounted  for  by  the  fact 
that  the  ground,  wood,  cement  or  brick  floor  on 
which  the  body  lies,  may  be  too  dry  to  carry  off 
the  high  static  charge  which  it  has  received,  and 
the  rescuer  on  grasping  it  may  experience  a  rather 
heavy  electrical  "  kick."  While  this  experience 
is  unusual,  yet  in  the  case  of  transformer  coils, 
after  high  voltage  tests,  it  is  found  they  fre- 
quently contain  a  high  static  charge,  which  re- 
mains for  many  minutes  after  the  apparatus  is 
disconnected  from  the  circuit. 

Generally  speaking,  the  higher  the  voltage 
involved,  the  greater  will  be  the  current  through 
the  body;  the  longer  the  duration  of  the  contact 
and  the  larger  the  number  of  points  of  contact, 
the  greater  the  danger  to  life.  Yet  the  human 
body  is  a  relatively  poor  conductor;  its  high 
resistance  greatly  reduces  the  amperage  of  the 
current.  It  is  generally  a  shunted  current  that 
the  man  receives,  a  mere  leakage  from  the 
line,  from  which  he  will  often  recover  if  properly 
resuscitated. 


14  ELECTRICAL  INJURIES 

The  voltage  being  equal,  alternating  current 
is  probably  less  dangerous  than  direct  current. 
With  alternating  current  frequencies  below  10,000 
cycles,  and  equal  voltage,  more  response  is  pro- 
duced than  in  frequencies  approaching  100,000 
cycles  per  second.  With  A.  C.  frequency  exceed- 
ing 10,000,  as  employed  in  electro-therapeutics, 
the  current  causes  neither  muscular  contractions 
nor  pain. 

An  interesting  contribution  on  ''  The  Physiol- 
ogical Tolerance  of  Alternating  Current  Strengths 
up  to  Frequencies  of  100,000  C3^cles  per  Second," 
by  A.  E.  Kennelly  and  E.  F.  W.  Alexander,  re- 
ported in  the  Electrical  World,  for  July  21,  1910, 
experimentally  adduces  these  facts: 

"  A  series  of  measurements  was  obtained  on  the 
same  patient  say,  at  five  frequencies  between 
15,000  and  100,000  cycles,  within  an  interval  of 
about  twenty  minutes.  The  limiting  current 
strength  which  the  subject  would  take  through 
his  arms  and  body,  mthout  marked  discomfort 
or  distress,  at  any  frequency,  may  be  designated 
as  the  tolerance  current  for  that  subject  and 
frequency. 

"  It  was  observed  that  the  tolerance  current 
increased  from  0.03  amp.  at  11,000  cycles  per 
second  to  about  0.45  amp.,  or  even  0.8  amp.,  at 
100,000  cycles  per  second.  This  means  that  the 
tolerance  cyclic  quantity  increases  from  about 
2.5  microcoulombs  per  cycle  at  11,000  cycles  per 


CAUSATION  OF  CONTACT  BURNS    15 

second  to  about  4.5  niicrocoulonibs  at  100,000 
cycles  per  second. 

"  It  was  tlie  unanimous  testimony  of  all  sul)- 
jects  experiencing  the  high-frequency  current 
that  at  or  near  100,000  cycles  per  second  there 
was  a  sensation  of  tingling  and  heat  in  the  wrists, 
when  the  tolerance  current  was  approached,  but 
no  muscular  contractions  were  produced,  either 
in  the  hands  or  arms.  When  the  frequency  was 
reduced  to  about  50,000  cycles  per  second, 
muscular  contractions  commenced  in  the  muscles 
of  the  forearms.  As  the  frequency  was  reduced 
below  50,000  cycles  per  second,  the  muscular 
contractions  became  more  evident." 

High  frequency  currents,  even  though  of  high 
voltage,  such  for  example  as  are  produced  by 
X-ray  induction  coils,  and  also  that  of  the  aerial 
side  of  ^vireless  telegraph  apparatus,  are  not 
ordinarily  dangerous,  on  account  of  their  tendency 
to  seek  the  surface  of  conductors  in  their  circuit 
rather  than  flow  by  way  of  internal  path.  This 
tendency  gives  rise  to  the  term  '^  skin  effect." 

While  burns  and  electrical  shock  are  often 
associated,  it  is  noteworthy  that  in  many  cases 
of  accidental  electrocution  there  are  no  demon- 
strable burns. 

The  calloused  palms  of  a  workingman  offer 
the  highest  electrical  resistance.  The  epidermis 
(the  outer  layer  of  the  skin)  limits  the  amount 
of  current  a  man  receives  from  a  circuit,  because 


16 


ELECTRICAL  INJURIES 


the  epidermis,  containing  no  blood  or  lymph,  is 
a  poor  conductor.  It  offers  this  high  electrical 
resistance,  pro\dded  the  skin  does  not  become 
moist  through  perspiration,  or  from  other  causes. 

Tabulated  figures  on  the  electrical  resistance 
of  the  human  body  varies  greatly.  For  example, 
by  the  bridge  method  on  the  Baker  Static  Ma- 
chine the  hand  to  hand  resistance  on  various 
individuals  was  found  to  be  40,000  ohms  (min.) 
to  140,000  ohms  (max.).  Moistening  the  hands 
cuts  the  hand  to  hand  resistance  to  29,000  ohms; 
immersing  the  hands  in  water  reduces  it  to  5400 
ohms,  and  making  the  water  conductive  by  the 
addition  of  salt,  further  reduces  it  to  4600  ohms. 

We  are  so  fortunate  as  to  secure  this  informa- 
tion from  H.  E.  Heath,  Consulting  Engineer, 
Baker  Electric  Company,  New  York  City, 
through  a  communication  for  The  Electric  Journal. 
The  definite  electrical  resistance  of  the  human 
body,  by  the  bridge  method,  is  expressed  in 
equivalent  ohms.  The  surfaces  are  dry;  six 
inches  tinfoil  contact. 

Min. 
Forehead  to  neck  (back) ....       3400  ohms 
Neck  (back)  to  chest 5300 

to  right  hand 14,000 

to  left  hand 26,800 

to  both  hands 10,850 

to  hip 18,500 

to  knee 120,000 

Hand  to  hand 40,000 

Hip  to  knee 47,000 


Max. 

4000  ohms 

7500 

60,000 

55,000 

35,000 

80,000 

170,000 

140,000 

165,000 


CAUSATION  OF  CONTACT  BURNS    17 

While  approximately  10  amps,  of  current  may 
be  involved  in  criminal  electrocutions,  with 
electrodes  at  base  of  brain  and  calf  of  legs,  yet 
tV  amp.  may  become  dangerous  under  certain 
conditions  of  contact  ^\^th  D.  C,  or  A.  C.  of  low 
frequency,  if  maintained  for  any  length  of  time, 
and  J  amp.  is  considered  prohibitive. 

A  current  that  is  harmless  at  first,  by  breaking 
(Xovm  the  skin  resistance  and  taking  an  internal 
path,  may  become  dangerous. 

Cases  are  recorded  where  the  ordinary  110- 
volt  60-cycle  lighting  circuit  proved  dangerous. 
Should  the  insulation  of  the  socket  be  defective, 
in  the  act  of  placing  an  incandescent  lamp  in 
the  socket,  or  in  turning  on  the  hght,  a  man  may 
come  in  contact  ^\'ith  the  circuit  and  receive  a 
current  from  the  hand  to  both  feet;  if  he  is  at 
the  time  in  a  bathtub,  his  hand  being  wet,  and 
his  feet  in  water,  or  even  if  he  is  standing  on  a 
damp  grounded  floor,  the  conditions  of  contact 
minimize  the  skin  resistance.  The  shock  may 
be  such  as  to  violently  flex  the  muscles  of  his 
hands,  and  render  him  powerless  to  release 
himself.  If  unassisted,  he  may  continue  to 
receive  current  until  death  results.  Again,  in 
the  presence  of  many  circuits,  wdth  certain  of 
them  grounded,  it  is  nearly  impossible  to  deter- 
mine from  w^hat  source  the  voltage  comes  that 
causes  the  injury.  The  voltages  may  be  increased 
or  diminished  in  their  resultant  joint  effects. 


18  ELECTRICAL  INJURIES 

The  location  and  number  of  contacts  is  an 
important  factor,  as  well  as  the  duration  of  the 
contact.  ''  A  small  current  applied  over  the 
pneumogastric  nerve  in  the  neck  would  paralyze 
the  heart,  whereas  taken  through  the  hands  or 
body,  the  path  must  be  over  the  nervous  mechan- 
ism controlling  the  respiratory  and  cardiac  cen- 
ters to  produce  death."  But  it  can  be  argued 
that  the  electric  current  follows  the  blood  vessels, 
not  the  nerve  trunks;  oil  is  a  non-conductor, 
the  nerve  trunks  are  chiefly  fat.  On  the  other 
hand,  the  saline  constituents  of  the  blood  make 
it  a  good  conductor. 

In  the  study  of  drugs  we  find  that  what  is  an 
overdose  of  a  certain  drug  for  one  individual  is  a 
remedial  dose  for  another.  This  peculiar  drug 
susceptibility  we  term  idios^^icrasy;  it  is  a 
peculiarity  that  cannot  be  accounted  for.  Sim- 
ilarly, in  the  passage  of  electric  current  through 
the  human  body,  a  quantity  of  current  that 
would  give  serious  shock  in  one  individual  would 
produce  merely  a  tingling  sensation  in  another. 

The  various  external  and  individual  circum- 
stances that  influence  the  extent  of  electrical 
injury,  in  the  grouping  of  Dr.  S.  Jellinek,  are: 
*' 1.  External:  (a)  voltage,  (5)  amperes,  (c)  num- 
ber of  poles  (points  of  contact),  (d)  time  Umitof 
contact,  (e)  the  kind  of  current  (A.  C.  or  D.  C). 
2.  Individual:  (a)  resistance  of  skin  and  body, 
(b)  the  path  of  the  current  through  the  body,  or 


CKIMINAL  ELECTROCUTIONS  19 

over  the  surface  of  the  skin,  (c)  the  condition  of 
the  mind  and  body." 

Criminal  Electrocutions  * 

In  this  connection  it  may  be  stated  that  in 
penal  electrocutions,  "  the  head,  chest,  arms  and 
legs  are  secured  by  broad  straps.  An  electrode, 
thoroughly  moistened  with  saturated  salt  solu- 
tion, is  affixed  to  the  head,  another  to  the  calf 
of  the  leg,  both  electrodes  being  so  molded  as  to 
insure  good  contact. 

"  The  contact  is  made  with  a  high  potential 
— 1800  volts^ — for  five  to  seven  seconds,  reduced 
to  200  to  250  volts  until  a  half  minute  has  elapsed; 
raised  to  high  voltage  for  three  to  five  seconds; 
again  reduced  to  low  voltage  until  one  minute 
has  elapsed,  when  it  is  again  raised  to  the  high 
voltage  for  a  few  seconds  and  the  contact  is 
broken.  The  ammeter  usually  shows  that  from 
7  to  10  amps,  have  passed  through  the  criminal's 
body.  .  .   . 

'^  At  the  moment  the  contact  is  made  the 
criminal's  body  stiffens  to  a  state  of  tonic  muscular 
spasm,  restrained  by  the  straps.  This  spasm 
abates  somewhat  as  the  voltage  is  reduced,  to 
again    attain    its   maximum   with   each   rise   of 

1  The  quotations  are  from  the  wTitings  of  Edward 
Anthony  Spitzka,  M.D.,  of  Philadelphia,  whose  numerous 
post  mortems  on  electrocuted  criminals  constitute  him 
the  leading  American  authority  on  Electrical  Death. 


20  ELECTRICAL  INJURIES 

voltage.  When  the  current  is  interrupted,  the 
body  collapses  completely.  .  .   . 

"  The  post  mortem  examination  of  electro- 
cuted criminals  reveals  a  number  of  interesting 
phenomena. 

"  The  temperature  of  the  body  rises  promptly 
and  reaches  as  high  as  120  to  129^°  F.,  within 
twenty  minutes  in  many  cases.  The  development 
of  this  high  temperature  is  to  be  regarded  as 
resulting  from  the  active  metaoolism  of  tissues 
not  (somatically)  dead  within  a  body  where  all 
vital  mechanisms  have  been  abolished,  there 
being  no  circulation  to  carry  off  the  generated 
heat.  The  maximum  of  heat  is  generated  at  the 
site  of  the  leg-electrodes,  where  muscle — myosin — 
coagulation  is  most  extensive.  Furthermore, 
the  release  of  from  10  to  20  horse-power  of  energy 
within  the  body  must  contribute  materially  to  the 
caloric  increase. 

"  The  heart,  at  first  flaccid  when  exposed  after 
death,  soon  contracts  and  assumes  a  tetanized 
condition.  This  is  particularly  marked  in  the 
left  ventricle.  On  the  whole  the  organ  assumes 
the  form  of  a  heart  in  systole.  .  .  .  This  con- 
tracted condition  of  the  heart  is  doubtless  due 
to  the  high  electromotive  force  of  the  fatal  cur- 
rent.    The  ventricles  are  found  empty. 

"  The  lungs  are  usually  devoid  of  blood  and 
weigh  only  seven  or  eight  ounces  avoirdupois 
each. 


CRIMINAL  ELECTROCUTIOXS  21 

''  The  blood  is  profoundly  altered  biochem- 
ically. It  is  of  a  very  dark  brownish  hue,  and 
it  rarely  coagulates.  Either  the  fibrinogen,  or 
the  fibrin  ferment,  or  both,  are  destroyed. 

"  The  maximum  damage  is  undoubtedly 
wrought  in  the  nerve  system,  though  this  is  not 
always  manifest.  Regarding  the  histologic 
changes,  reports  from  various  sources  differ. 
There  is  a  general  agreement  as  to  the  frequent 
occurrence  of  capillary  hemorrhages,  disruptive 
and  destructive  for  adjacent  tissues.  In  the 
nerve  cells  themselves  there  appears  to  be  no 
apparent  change,  although  there  must  have  re- 
sulted terrific  molecular  changes.  P.  A.  Fish 
found  vacuoles  in  one  case,  but  no  visible  changes 
in  another.  Aside  from  the  capillary  hemorrhages 
and  the  arterial  anaemia  with  venous  conges- 
tion, the  brain  shows  no  gross  changes  of  appear- 
ance. In  a  case  of  accidental  death  from  contact 
with  an  alternating  current  of  1000  volts  for 
about  one-half  minute,  Jellinek  found  extensive 
streaks  of  capillary  hemorrhages  in  the  gray 
substance  of  the  brain  and  spinal  cord,  together 
with  more  or  less  destruction  of  the  nerve  cells, 
extension  of  the  cell  nucleus,  etc." 

In  cases  presenting  such  phenomena,  no 
recovery  is  possible  under  any  method  of  resus- 
citation. But  the  presumable  condition  present 
in  the  victim  of  electrical  shock,  viz.,  blood 
altered,  veins  altered  and  full  of  blood,  arteries 


22  ELECTRICAL  INJURIES 

nearly  empty,  heart  feebly  pulsating,  respira- 
tion ceased — requires  immediate  artificial  res- 
piration. 

Theories  of  Electrical  Shock 

Physiological  experimentation  on  animals  ad- 
duces the  conclusion  that  in  suspended  anima- 
tion (cessation  of  respiration  and  cardiac  action) 
from  electrical  over-stimulation  the  brain  loses 
its  power  to  react  to  stimuli.  This  irritation 
(power  to  react)  is  only  temporarily  suspended, 
so  that  life,  if  not  entirely  extinct,  is  dependent 
on  artificial  respiration  until  such  time  as  the 
brain  (the  control  board  of  the  central  station 
plant)  recovers  its  irritability.  The  action  of 
the  brain  is  like  that  of  the  dry  battery  of  a 
common  door  bell,  which,  if  rung  too  contin- 
uously, exhausts  the  battery  so  that  the  bell 
ceases  ringing.  Thus,  if  over-stimulated  to  the 
point  of  exhaustion,  the  brain  suspends  vital 
operation.  The  dry  battery  left  to  itself  re- 
covers, and  the  bell  will  ring  again;  the  brain 
possesses  infinitely  greater  power  of  recovery. 
But  under  the  extreme  condition  resulting  from 
electric  shock  artificial  respiration  must  be 
employed  to  supply  oxygen,  so  that  oxygenated 
blood  may  help  sustain  the  heart  action,  else 
there  ^vill  be  no  interval  of  rest  allowed  the 
exhausted   brain    in   which   to    recover.     While 


THEORIES  OF  ELECTRICAL  SHOCK       23 

the  irritability  of  the  brain,  which  subsides 
immediatel}^  after  the  shock,  will  within  a  few 
minutes  recover,  everything  depends  finally, 
where  artificial  respiration  is  employed,  on 
whether  the  action  of  the  heart  continues  or  not. 

A  second  theory  is  that  of  asphyxiation,  or 
the  non-oxygenation  of  the  blood.  There  is  a 
heightened  chemical  activity  (electrolj^sis)  and 
accelerated  metabolism  from  the  current  that 
induces  the  electrical  shock  and  much  carbon 
dioxide  and  other  toxic  products  are  produced. 
The  excess  of  carbon  dioxide  in  the  blood  paralyzes 
the  respiratory  center  in  the  medulla,  the  phys- 
iological co-ordinating  center  of  the  brain. 
In  asphyxia  artificial  respiration  is  required, 
and  must  be  continued  until  the  blood  is  oxy- 
genated, before  the  normal  respiratory  function 
will  be  re-established. 

A  third  theory  makes  electrical  shock  depend 
upon  a  sudden  dilatation  of  the  great  vessels  of 
the  splanchnic  area  (those  of  the  abdominal 
viscera).  The  blood  vessels  are  held  in  a  state 
of  tonic  constriction  by  nerves  of  the  sym- 
pathetic nervous  system.  The  shock  is  con- 
veyed from  the  cerebro-spinal  nervous  system 
to  the  sympathetic  nervous  system.  This  tonic 
constriction  of  the  splanchnic  vessels  is  suddenly 
recalled  and  suppressed,  and  in  a  moment  these 
vessels  dilate  to  twice  their  normal  diameter, 
able  to  contain  four  times  the  quantity  of  blood 


24  ELECTRICAL  INJURIES 

normally  contained,  and  the  man  in  shock  is 
accordingly  liable  to  die  of  hemorrhage  into  his 
own  blood  vessels.  Paradoxically,  he  can  die 
of  hemorrhage  in  this  state  without  shedding  a 
drop  of  blood. 

Respiration  Tvdll  cease  at  once  from  anaemia 
of  the  medulla.  The  brain  depends  for  its  blood 
tension  on  the  tonicity  of  the  vessels  of  the 
splanchnic  area.  Not  only  Tvdll  the  brain  be 
without  blood,  but  the  heart  will  have  no  blood 
to  impel  into  the  arteries,  and  unless  artificial 
respiration  is  resorted  to  instantly  the  increasing 
asphjTd-a  will  speedily  result  fatally. 

Breaking  the  Contact 

The  voltage  may  cause  a  rigid  contraction  of 
the  flexor  muscles,  so  that  the  victim  cannot 
free  himself  from  the  accidental  contact. 

If  there  is  a  circuit  breaker  near  at  hand,  cut 
off  the  current  at  once;  if  none,  remove  the  body 
from  the  circuit  by  means  of  any  dry  noD- 
conductor,  such  as  a  dry  piece  of  wood,  or  a 
tool,  such  as  a  pick  or  shovel  having  a  dry  wooden 
handle.  Either  push  or  roll  the  body  aside,  or 
pull  away  the  conductor.  The  rescuer  can  stand 
on  a  real  dry  wood  or  concrete  floor  and  pull 
away  the  body  from  the  conductor,  without 
danger  to  himself;  or  he  can  catch  the  victim's 
clothing,  or  he  can  safely  grasp  the  body  of  the 


BREAKING  THE  CONTACT  25 

victim   if   his   hands    are   protected   by   several 
thicknesses  of  drj-  cloth. 

If  other  methods  are  impossible  it  may  be 
possible  to  short-circuit  the  line  ^vith  which  the 
victim  is  in  contact,  and  thus  cause  the  circuit 
breaker  to  open  the  circuit,  or  blow  the  fuses 
which  protect  that  part  of  the  electric  system. 
A  short-circuit  may  be  made  by  throwing  a 
chain,  a  bar,  or  a  piece  of  pipe  across  the  two 
conductors  of  the  circuit,  so  that  the  electric 
current  will  have  a  direct  metallic  path  in  pref- 
erence to  one  through  the  body  of  the  victim. 
In  case  the  victim  is  in  contact  with  a  trolley 
vdre,  for  example,  a  metal  pipe,  or  a  length  of 
wire,  should  be  placed  firmly  in  contact  with  the 
track  rail  and  then  thrown  across  the  trolley 
'vvire,  so  as  to  be  in  contact  with  both.  In  doing 
this  great  precaution  must  be  observed;  unless 
one  end  of  the  metal  short-circuiting  piece  is  very 
positively  grounded  it  should  leave  the  hand 
before  it  touches  the  current-carrying  part  of  the 
circuit,  as  otherwise  there  is  equal  danger  to  the 
rescuer  of  being  shocked.  The  safest  procedure 
is  to  handle  the  metal  piece  with  the  hands 
thoroughly  insulated  from  it. 

This  method  is  of  course  least  dangerous  in 
the  case  of  low  voltage,  as  with  high  voltage  there 
is  increased  liability  that  an  arc  would  form. 
The  flame  of  the  arc  in  this  instance  might 
seriously  burn  the  person   attempting  to  open 


26  ELECTRICAL  INJURIES 

the  line  by  short-circuiting,  and  might  also  fur- 
ther injure  the  person  whose  rescue  was  bein-g 
sought.  There  is  no  need  of  being  reckless  in 
rescuing  a  comrade  from  an  electric  circuit. 
Rescue  work  must  be  done  quickly  but  intel- 
ligently. To  open  the  circuit  by  means  of  a 
nearby  circuit  breaker  or  switch,where  practicable, 
is  the  surest  way  of  getting  the  victim  out  of 
the  circuit.  Striking  him  with  a  block  of  wood, 
or  pulling  him  off  by  his  clothing,  or  otherwise, 
is  less  certain. 

Resuscitation  by  Artificial  Respiration  ^ 

The  efforts  at  resuscitation  must  be  begun  the 
instant  the  patient  is  freed  from  the  contact. 
Sixty  seconds  is  too  long  for  preliminaries.  The 
comrade  nearest  him  must  know  how  to  give 
artificial  respiration,  as  loss  of  time  in  summoning 
a  physician  is  unpardonable.  The  services  of 
the  latter  are  often  essential  in  winning  back  the 
life,  but  the  artificial  respiration  must  be  begun 
early,  and  perseveringly  continued,  if  it  is  to  be 
saved.  Whether  he  be  only  apparently  dead,  or 
actually  beyond  all  human  aid  cannot  be  pre- 
dicted; we  must  help  him  to  live. 

While  the  heart  beats  there  is  hope.  Artificial 
respiration    helps    sustain    the    cardiac    action. 

1  See  The  Journal  of  the  American  Medical  Association, 
Vol.  LI,  No.  10,  and  C oilier' s,\o\.  XLI,  No.  25,  for  articles 
on  Resuscitation  by  the  Prone  Pressure  (Schaefer)  method. 


RULES   FOR  ARTIFICIAL  RESPIRATION     27 

Even  when  no  radial  wrist  pulse  is  felt,  the 
comrades  are  not  justified  in  ceasing  their  efforts 
at  resuscitation,  as  the  heart  may  still  be  beating 
feebly.  In  the  occasional  cases  where  the  heart 
action  has  ceased,  as  the  physician  upon  his 
arrival  may  determine  with  his  stethoscope, 
there  will  be  no  possibility  of  restoring  the  nor- 
mal respiration  by  any  method  of  artificial 
respiration.  Yet  the  victim  should  have  the 
benefit  of  any  doubt,  for  there  are  few  cases 
of  electrical  accident  where  the  victim  cannot 
be  restored  from  the  electrical  shock,  if  appro- 
priate immediate  efforts  at  resuscitation  are 
instituted. 

Rules  for  Artificial  Respiration 

The  three  essentials  of  the  Prone  Pressure 
method  of  artificial  respiration  to  be  remembered 
and  practiced  in  anticipation  of  an  emergency 
are  as  follows: 

I.  The  man  is  laid  upon  his  stomach,  face 
turned  to  one  side,  so  that  the  mouth  and  nose 
do  not  touch  the  ground. 

II.  The  operator  kneels,  straddling  the  patient's 
hips,  or  kneels  by  either  side  of  the  hips,  facing 
the  patient's  head. 

III.  The  operator  places  his  spread  hands  upon 
the  lower  ribs  of  the  patient  and  throws  his 
body  and  shoulders  forward,  so  as  to  bring  his 
weight  heavily  upon  the  lower  ribs  of  the  patient. 


28  ELECTRICAL  INJURIES 

The  operator's  downward  pressure  should 
occupy  about  three  seconds,  then  his  hands  are 
suddenly  released.  It  is  well  to  remove  the 
hands  entirely. 

The  pressure  should  be  begun  light,  and  in- 
creased gradually  up  to  the  end  of  the  three 
seconds;  the  pressure  should  be  uniform  in  each 
act,  and  the  rate  uniform,  as  sudden  thrusts  and 
irregularity  in  speed  too  little  resemble  natural 
respiration.  The  operator's  arms  should  be 
straight,  not  bent  at  the  elbows,  and  the  weight 
should  come  from  the  shoulders.  Pressure  on 
the  ribs  is  made  with  the  heel  of  the  hand  (the 
thenar  and  hypothenar  eminence). 

This  act  should  be  repeated  an  indefinite 
number  of  times  at  the  rate  of  twelve  times  a 
minute.  In  the  excitement  of  the  occasion  the 
danger  is  that  the  rate  ^vdll  exceed  sixteen  times 
a  minute;  fourteen  is  a  good  average.  If  the 
operator  is  alone  with  the  patient  he  can  adjust 
the  rate  of  giving  artificial  respiration  by  his  own 
deep,  regular  breathing;  if  more  persons  are 
present,  a  watch  can  be  used  to  advantage  to 
regulate  the  rate. 

The  abdomen  is  pressed  against  the  ground 
and  the  diaphragm  is  thereby  pushed  up  by  the 
viscera  (liver,  spleen,  etc.).  This  empties  the 
lungs  of  air  and  on  the  release  of  pressure,  the 
resiliency  of  the  chest  walls  creates  a  partial 
vacuum,   causing  the  lungs  to  be  refilled  with 


SUPPLEMENTAL  EFFORTS  29 

fresh  air;  the  operation  is  analogous  to  the  action 
of  a  bellows. 

By  spreading  the  fingers  over  the  lowest  ribs, 
one  gets  a  certain  amount  of  pressure  upon  the 
lowest  part  of  the  chest,  which  helps  a  little; 
though  "  the  efficacy  of  the  method  depends 
mainly  upon  abdominal  pressure." 

Any  evidence  of  returning  animation  should 
encourage  the  operator  to  continue  his  efforts. 
It  often  requires  one-half  hour  to  two  hours. 
In  electrical  shock  seldom  over  one-half  hour 
is  required,  but  in  cases  of  drowning,  especially, 
it  is  advisable  to  keep  at  it,  for  recoveries  are 
alleged  to  have  resulted  after  three  hours  of 
continuous  artificial  respiration.  This  same 
method  is  applicable  for  asphyxiation  from  what- 
ever cause. 

The  four  points  to  be  especially  remembered 
in  connection  with  the  Prone  Pressure  method  are : 

I.  Position  of  the  patient. 

II.  Posture  of  the  operator. 

III.  The  mode  of  operation. 

IV.  Rate  per  minute,  and  duration  of  operation. 

Supplemental  Efforts 

If  the  operator  is  alone  with  the  patient,  the 
artificial  respiration  is  his  chief  concern,  and  offers 
the  only  hope  for  the  victim.  Yet  if  others  are 
present  they  may  keep  back  the  crowd,  loosen 


30  ELECTRICAL  INJURIES 

tight  neckbands,  if  anj^  and  hold  a  cloth  saturated 
with  Aromatic  Spirits  of  Ammonia  near  the  nose. 
As  a  respiratory  stimulant  it  is  even  more  useful 
than  oxygen,  yet  is  valuable  only  as  an  adjunct 
to  the  artificial  respiration. 

The  physician  upon  his  arrival,  should  the 
respiratory  function  continue  in  abeyance,  may 
render  great  assistance  by  the  hypodermic 
administration  of  Atropin  Sulph.  gr.  to^o  and 
Strychnin  Sulph.  gr.  ^,  which  can  be  repeated 
at  his  discretion,  or  he  can  stretch  the  sphincter 
ani. 

Injudicious  assistance  is  often  harmful.  No 
liquids  should  be  given  by  the  mouth  to  an 
unconscious  patient.  Under  conditions  met  with 
in  electrical  shock,  and  in  those  near  drowmed, 
liquids  given  are  more  liable  to  enter  the  lungs 
than  the  stomach. 

When  the  rhythm  of  the  respiration  is  re- 
established and  consciousness  is  restored,  the 
patient  may  experience  thirst  and  may  be 
encouraged  to  drink  a  teaspoonful  of  aromatic 
spirits  of  ammonia  in  one-half  glass  of  water, 
and  the  same  repeated  after  a  short  interval. 
He  may  be  cold  and  weak  and  in  that  case  will 
require  blankets  and  artificial  heat;  or  he  may 
be  strong  as  ever,  in  which  case  it  helps  to  wake 
him  up  to  allow  him  to  walk  with  assistance  a 
reasonable  distance  to  the  physician  to  have  his 
accompanying  burns  dressed. 


PRONE  PRESSURE  METHOD  31 

Yet  a  word  of  caution  is  here  necessary.  When 
artificial  respiration  has  succeeded  and  the 
patient  is  recovering  from  the  electrical  shock, 
he  may  be  excited  and  may  desire  to  stand  up 
too  soon.  He  must  be  dissuaded  from  doing  so 
until  fully  out  of  the  shock — his  heart  and  breath- 
ing fully  restored — before  he  "is  permitted  to  sit 
up,  and  finally  stand  up.  He  needs  watching 
for  some  time.  If  he  gets  up  too  soon  a  second 
effort  at  artificial  respiration  may  be  unavailing; 
it  may  be  the  collapse  of  heart  failure. 

Advantages  of  the  Prone  Pressure  Method 

The  Prone  Pressure  method  is  best  because: 
(1)  It  is  easy  to  learn.  Any  intelligent  man 
may  be  instructed  in  a  few  minutes  and  can 
practice  on  his  friends,  and  they  on  him,  until 
he  becomes  an  expert  in  the  art  of  giving  artificial 
respiration.  (2)  It  requires  no  apparatus.  There 
is  no  delay  in  waiting  until  an  emergency  outfit 
is  found.  (3)  It  can  be  carried  on  easily  by  one 
person.  A  mere  boy  of  twelve  can  resuscitate 
an  overweight  adult  and  maintain  sufficient 
inflow  and  outflow  of  air  (tidal  air),  as  much  as 
he  would  secure  were  he  able  to  breathe  voluntar- 
ily. One  operator  can  work  without  exhaustion 
for  an  unlimited  length  of  time  by  this  method; 
there  is  no  need  of  team  work,  and  teams  work- 
ing in  relays,  as  for  example  with  the  Sylvester- 


32  ELECTEICAL  INJURIES 

Laborde  method.  Hence,  there  is  diminished 
temptation  to  quit  too  soon.  (4)  Spirometer 
tests  show  the  Prone  Pressure  method  superior 
in  the  amount  of  tidal  air  handled,  as  exhibited 
by  Prof.  E.  A.  Schaefer  of  Edinburgh  before  the 
American  Medical  Association.  (5)  It  is  the 
method  that  best  meets  the  complications  of 
suspended  animation  as  encountered  in  electrical 
shock:  (a)  In  the  usual  excessive  relaxation  of 
electrical  shock,  there  is  great  liability  of  swallow- 
ing the  tongue  with  the  patient  on  the  back,  and 
considerable  difficulty  in  holding  it  forward; 
by  the  Prone  Pressure  method,  with  the  man  on 
his  abdomen,  the  tongue  falls  forward  of  its 
o^vn  weight.  (6)  In  the  frequent  bronchorrhea 
(excessive  secretion  from  the  air-passages)  and 
edema  of  the  lungs  (leakage  of  blood-stained 
serum  into  air-vesicles)  by  laying  the  man  prone 
on  his  stomach,  these  secretions  run  out  of  the 
mouth,  and  there  is  no  danger  of  drowning  the 
man  in  his  o^vn  secretions.  By  the  older  method, 
where  this  complication  was  successfully  met, 
the  patient  had  to  be  rolled  on  his  stomach 
occasionally  to  permit  of  the  escape  of  bloody 
mucus,  then  rolled  on  his  back,  and  the  secre- 
tions churned  up  in  his  lungs  until  the  artificial 
respirations  were  another  time  interrupted  by 
rolling  him  on  his  abdomen  to  let  the  secretions 
escape  from  his  mouth,  (c)  In  cases  of  electrical 
shock  presenting  muscular  rigidity  there  may  be  a 


SYMPTOMS  OF  CONTACT  BURNS  33 

continuous  contraction  of  the  muscles,  tetanic 
in  character;  his  arms  cannot  be  manipulated. 
By  pressure  on  the  ribs,  according  to  the  Prone 
Pressure  method,  and  simultaneous  pressure  on 
the  abdomen  by  a  second  comrade,  mucus  is 
expelled  from  the  mouth  in  a  brief  period,  and 
with  the  first  forced  expiration  there  comes  a 
general  muscular  relaxation,  and  continued  artifi- 
cial respiration  leads  to  recovery.  (6)  With  the 
patient  on  his  back,  a  folded  coat  under  his 
shoulders,  his  head  is  too  much  lowered,  when  the 
Sylvester-Laborde  method  is  employed.  Spitzka 
raises  the  head,  not  the  shoulders,  and  does  not 
manipulate  the  arms,  so  as  to  diminish  the 
tendency  to  any  increase  of  hemorrhages  in  the 
brain  and  cord.  Spitzka  places  the  victim  of 
electrical  shock  on  his  back,  and  relies  upon 
rhythmic  abdominal  pressure  as  a  mode  of 
artificial  respiration,  in  a  manner  quite  analogous 
to  the  Prone  Pressure  method,  yet  that  method 
requires  a  tongue  forceps  in  the  hands  of  a  second 
person. 

Symptoms  of  Contact  Burns 

The  burns  from  electrical  contact  are  generally 
of  the  third  degree;  that  is,  there  is  a  destruction 
of  both  layers  of  the  skin,  and  even  of  deeper 
tissues.  The  real  extent  is  not  immediately 
apparent.     The  tissues  are  coagulated,  and  there 


34  ELECTRICAL  INJURIES 

is  a  deep  white  slough  that  is  slow  in  separating. 
At  times,  fingers  are  burned  to  a  cinder,  or  the 
vascular  supply  so  destroj^ed  as  to  cause  a  dry 
gangrene.  These  burns  are  as  a  rule  painless, 
and  upon  recovering  from  the  shock  the  patient 
may  not  consider  himself  burned,  but  later  the 
discovery  is  made.  In  the  milder  forms  they  may 
not  report  for  treatment  until  some  days  after 
the  accident,  by  which  time  the  burn  has  become 
infected.  But  these  burns  are  worse  than  they 
look  and  are  obstinate  to  heal,  especially  after 
infection  sets  in.  Ordinarily,  in  the  milder 
cases,  the  patient  is  best  treated  while  continuing 
at  work.  In  the  severer  degrees,  as  above  men- 
tioned, they  are  hospital  cases. 


Treatment  of  Contact  Bums 

The  immediate  treatment  of  such  burns  con- 
sists in  surgical  cleanliness,  secured  by  ethereal 
soap  applied  by  numerous  sponges.  For  the 
milder  burns,  w^e  prefer  Deplettol,  or  10  per  cent 
Ichthyol  on  sterile  gauze,  to  facilitate  the  sepa- 
ration of  necrosed  (dead)  tissues.  When  the 
slough  has  separated,  we '  commonly  employ 
Balsam  of  Peru  as  a  dressing,  and  alternate  with 
Thymol  Iodide  at  times.  When  crusts  form  under 
this  mode  of  treatment,  we  employ  Zinc  Oxide 
ointment,  to    remove    them,    and    continue  the 


FORETHOUGHT  35 

daily  dressings  until  the  defect  has  granulated 
in  and  the  area  is  covered  with  healthy  skin. 
The  severer  burns  in  hospital  practice  are 
treated  by  open,  dry  or  wet  methods,  in  accord- 
ance with  the  ideas  of  the  surgeon  on  the  par- 
ticular service.  It  is  customary  to  be  con- 
servative in  waiting  for  gangrene  to  demark  the 
necrosed  tissues,  rather  than  to  resort  to  imme- 
diate amputations,  inasmuch  as  the  boundaries 
of  the  damaged  tissues  cannot  be  immediately 
determined.  Burns  of  the  palms,  which  to  the 
uninitiated  may  seem  trivial,  may  necessitate 
the  amputation  of  the  hands,  due  to  necrosis  of 
the  tendons. 


Forethought 

Suspended  animation  requires  instant  relief, 
yet  so  often  many  who  have  been  trained  to 
give  artificial  respiration  are  helpless  in  such  an 
emergency.  Many  are  excited,  frenzied.  All 
turn  white.  Some  jump  up  and  dowm,  others 
scream,  and  are  incapable  of  intelligent  action. 
With  deliberate,  prudent  forethought,  akin  to 
the  German  Bureau  of  Strategy,  each  individual 
must  study  out  in  advance  just  what  he  would 
do  under  given  circumstances — if  his  home  or 
factory  were  on  fire,  or  a  comrade  were  on  an 
electric  circuit.     Every  action  must  be  carefully 


36  ELECTRICAL  INJURIES 

thought  out  in  advance.  Testers  should  know 
if  the  floor  is  a  non-conductor,  and  should  know 
the  location  of  switches  that  may  be  opened, 
or  the  methods  of  pulling  a  man  off  by  his  cloth- 
ing, or  otherwise,  in  such  manner  that  the  rescuer 
is  safe.  Then  he  must  previously  study  out  and 
know  how  to  give  artificial  respiration,  so  that 
there  will  be  nothing  unforeseen,  nothing  unan- 
ticipated, in  an  apparent  calamity  that  spreads 
consternation  particularly  among  those  not 
quahfied  to  meet  the  responsibilities  of  the 
situation. 


Are  Too  Many  Deaths  Attributed  to  Electricity? 

It  should  be  remembered  that  panic  (the 
emotions),  causing  great  vascular  dilatation  from 
slight  injury,  as  before  related,  and  subsequent 
failure  to  perform  artificial  respiration,  probably 
accounts  for  many  deaths  attributed  to  electric- 
ity, in  cases  where  life  could  be  saved  by  any 
good  method  of  resuscitation.  Deaths  under 
these  circumstances  are  due  to  neglect;  the 
resuscitation  is  delayed,  improperly  conducted, 
or  discontinued  too  soon.  The  electrolytic  action 
of  the  current  on  the  man's  blood  has  produced 
too  much  carbon  dioxide.  As  he  is  being  rapidly 
asphyxiated  by  it  he  will  die,  unless  assisted  by 
artificial  respiration. 


DEATHS  ATTRIBUTED  TO  ELECTRICITY     37 

Does  artificial  respiration  save  life?  An  electri- 
cian in  our  plant  within  six  years  in  his  own  de- 
partment has  rescued  six  from  death's  door; 
six  out  of  six,  a  record  of  100  per  cent  saved. 
He  is  there  within  three  seconds,  and  begins  the 
artificial  respiration  in  the  spot  where  they  fall, 
and  keeps  by  them  in  that  spot  until  they  have 
fully  recovered.  He  is  enthusiastic  for  the  Prone 
Pressure  method. 

This  outline  sketch  of  electrical  injuries  is 
designed  to  emphasize  the  curability  of  this 
t}T3e  of  accidents,  if  skilfully  handled,  not  to 
encourage  patients  to  try  to  treat  themselves. 
Yet  it  is  designed  to  insist  that  everybody, 
especially  electrical  men,  learn  how  to  give  arti- 
ficial respiration  by  the  Prone  Pressure  method, 
with  the  purpose  of  minimizing  the  number  of 
fatalities  from  electrical  shock. 

While  pulmotors — the  automatic  oxygen  pul- 
motor  (Draeger)  is  splendid  for  the  gas  asphyxia 
of  mines — for  pumping  air  into  the  lungs  and  out 
of  them,  and  electrical  devices  for  stimulating 
cardiac  and  respiratory  action  are  on  the  market, 
yet  these  and  other  appliances  can  never  wholly 
supersede  manual  methods  of  resuscitation. 
Whatever  in  the  way  of  equipment  may  some 
day  merit  general  adoption,  we  know  that  no 
reliance  can  be  placed  on  any  outfit  that  cannot 
be  carried  with  every  electrical  workman,  and 
that  is  not  instantly  available.     We  know  that 


38  ELECTRICAL  INJURIES 

success  in  artificial  respiration  is  attained  by  the 
Prone  Pressure  method,  and  by  other  methods. 
Indeed,  ignorance  of  a  method  of  resuscitating  a 
comrade  is  criminal  negligence  on  the  part  of  any 
man  of  normal  intelligence  and  conscience. 


MINOR  SURGERY  AND  FIRST  AID 

A  WOUND  is  a  breach  of  the  skin  and  flesh;  it 
is  an  incised  wound  when  the  skin  is  severed  by  a 
cutting  instrument,  such  as  a  knife;  a  lacerated 
wound  when  made  by  a  blunt  instrument,  with 
rough  uneven  outlines,  accompanied  often  with 
much  bruising  (contusion)  of  the  tissues;  a 
puncture  wound  when  from  a  sharp  instrument, 
as  in  tramping  on  a  nail,  receiving  a  stab  wdth  a 
knife,  or  a  bullet  wound,  characterized  by  great 
depth  and  hmited  surface  injury. 

The  danger  of  a  wound  depends  upon  the 
structures  severed  or  penetrated;  veins  and 
arteries  may  be  opened,  nerves  and  tendons 
severed  (requiring  accurate  approximation  and 
suturing),  or  organs  penetrated,  as  brain,  lungs, 
liver,  intestines,  etc.  External  appearances  often 
give  very  meagre  indications  of  the  damage 
inflicted. 

For  complete  recovery  of  function,  bone  must 
be  reunited  to  bone,  tendon  sutured  to  tendon, 
nerve  to  nerve,  muscle  to  muscle,  skin  to  skin. 

The  slightest  wounds,  miniature  abrasions 
of  the  skin,  may  give  rise  to  dangerous  infections 
b}'  the  entrance  of  infectious  bacteria.     When 

39 


40  ELECTRICAL  INJURIES 

infection  sets  in  there  may  be  an  area  of  swelling 
and  redness  about  the  wound,  and  a  red  line 
(ascending  lymphangitis)  leading  upwards  to 
the  nearest  lymph  node.  Pain,  heat,  pulsation 
develop  in  the  wound,  and  there  may  be  some 
rise  of  temperature  above  the  normal  98.6  de- 
grees. Such  is  the  mcipient  state  of  "  blood- 
poisoning." 

Infected  wounds  require  the  skilful  attention 
of  a  ph^^sician,  and  the  emplojTaent  of  such 
antiseptic  remedies  as  w^ll  destro}^  and  reduce  in 
virulence  the  invading  bacteria,  thereby  controll- 
ing and  eliminating  the  infection,  with  the  least 
injury  to  the  tissues  of  the  patient. 

Treatment.  Very  slight  abrasions  may  be 
painted  with  Tincture  Iodine;  wrap  cotton  on 
toothpick,  immerse  it  in  the  Tincture  Iodine, 
and  paint  the  site  of  the  abrasion. 

Where  the  injury  is  larger  than  a  pin  prick, 
it  is  prudent  to  seek  the  services  of  some  physician 
competent  to  give  suitable  attention  to  the  injury. 

The  area  about  the  injurj^  should  be  thorough!}^ 
cleaned  with  ethereal  soap,  and  turpentine, 
benzine,  or  other  detergent  employed  to  remove 
an}^  special  grime,  then  T\ith  hands  thoroughly 
cleaned,  the  wound  itself  is  cleaned,  using  many 
changes  of  cotton  mops  saturated  with  surgical 
soap.  Often  a  knife,  currette  and  forceps  are 
required  to  scrape  out  foreign  materials  in  the 
wound.     The   hair  must   be  shaved    away,  and 


MINOR  SURGERY   AND  FIRST  AID        41 

the  infecting  bacteria  reduced  in  quantity,  and 
their  virulence  so  far  as  possible  impaired  by 
agents  that  will  destroy  bacteria  without  de- 
vitalizing the  tissues  of  the  patient.  For  this 
purpose  Tincture  Iodine  and  Lugol's  Solution 
are  probably  the  best,  for  mopping  out  the 
wound  before  applying  sterile  dressings. 

Hemorrhage  from  a  wound  is  a  good  thing; 
the  blood  is  clean;  it  aids  in  cleansing  the  wound, 
and  is  a  perfect  dressing  for  the  wound,  after  it 
has  been  properly  cleansed  by  scrubbing  and 
scraping.  Blood  coming  in  squirts  is  arterial 
blood;  if  in  a  steady  stream  it  is  venous  blood; 
when  oozing  from  a  wound  it  is  capillary  blood. 
Do  not  try  to  stop  the  flow  of  blood  unless  it  is 
very  severe.  *A  pad  of  sterile  gauze  over  the 
seat  of  the  hemorrhage  and  a  bandage  applied 
will  stop  severe  venous  and  capillary  hemorrhage ; 
a  handkerchief  or  suspender,  or  a  few  turns  of 
bandage,  above  the  elbow  or  knee — a  stick 
inserted  under  it,  and  t\visted — \vill  stop  bleeding 
anywhere  below  the  elbow  or  below  the  knee. 
However,  no  form  of  tourniquet  should  be  em- 
ployed before  the  patient  is  taken  to  the  physician, 
unless  absolutely  needed.  Let  the  physician  or 
his  trained  assistants  wash  the  wound,  if  they  are 
to  be  responsible  for  it;  dirt  can  be  washed  into 
the  wound  as  well  as  out  of  it,  and  incalculable 
damage  may  be  done  by  meddlesome  first  aid 
interference. 


42  ELECTRICAL  INJURIES 

Burns  due  to  heat,  steam,  electricity,  chemicals 
- — can  be  covered  at  once  with  cotton  soaked  in 
Carron  Oil  for  the  relief  of  pain  until  properly 
washed;    they  require  skilled  attendance. 

Fractures,  where  there  is  complete  separation 
of  the  fragments,  require  careful  handling  of  the 
part;  a  light  board  or  an  umbrella  can  be  im- 
provised as  a  temporary  splint  for  a  broken  leg, 
or  this  can  be  dispensed  with,  if  the  patient  is 
laid  carefully  on  a  stretcher  and  carried  at  once 
to  the  doctor's  office.  Careless  handling  may 
cause  the  jagged  fragments  of  bone  to  penetrate 
the  superimposed  muscles,  nerves,  and  blood- 
vessels, or  puncture  the  skin  (converting  a  simple 
fracture  into  a  compound  fracture),  producing 
alarming  and  perhaps  serious  complications. 

Fractures,  dislocations,  sprains  are  best  dif- 
ferentiated by  the  physician;  where  deformity 
and  other  sj^mptoms  are  marked,  it  is  a  clear 
case,  but  at  other  times  the  aid  of  the  X-ray  is 
desirable  for  the  sake  of  certainty  of  diagnosis. 

Asphyxia  from  drowning,  gas-poisoning,  opium- 
poisoning,  etc.,  can  be  relieved  by  artificial 
respiration,  by  the  Prone  Pressure  method,  as 
described  in  the  foregoing  chapter. 

A  disposition  to  fainting,  and  many  cases  of 
dizziness,  headache,  sick  stomach,  are  relieved 
by  giving  one  teaspoonful  of  aromatic  spirits 
of  ammonia  in  one-half  glass  of  water.  When  a 
person   seated   in   a   chair   has   fainted,   prompt 


MINOR  SURGERY  AND   FIRST  AID        43 

relief  is  assured  by  bending  his  head  forward 
between  his  knees  for  a  few  moments;  or  by 
laying  the  patient  on  his  back,  on  the  floor  where 
he  has  fallen,  exercising  care  that  the  head  be 
lower  than  the  heels. 


INFECTIONS 

All  nature,  where  inhabited  by  man,  is  infested 
with  low  forms  of  vegetable  life,  some  of  which 
are  dangerous  to  man,  others  l^eneficial  to  him. 
These  micro-organisms  are  knowTi  as  bacteria; 
they  are  the  minutest  and  most  hardy  of  the 
plants.  They  are  so  small  that  a  millimeter 
has  to  be  divided  into  one  thousand  parts,  con- 
stituting a  micron,  for  measuring  them.  Their 
study  began  practically  with  the  invention  of  the 
oil  immersion  microscope,  as  magnification  of 
one  thousand  diameters  is  essential  for  their 
accurate  observation.  The  problem  of  special 
media  for  growing  them  and  special  chemical 
stains  for  coloring  and  discoloring  them,  has 
developed  into  an  exact  science,  the  branch  of 
biochemistry  known  as  bacteriology.  So  small 
are  some  of  these  little  plants  that  four  hundred 
millions  of  them  will  be  no  larger  than  a  grain  of 
granulated  sugar.  So  rapidly  do  they  multiply 
that  there  is  a  new  generation  every  half  hour; 
they  multiply  by  each  dividing  into  halves,  then 
in  another  half  hour  each  of  these  will  divide 
into  halves.     By  the  end  of  the  first   day,   at 

44 


INFECTIONS  45 

this  geometrical  ratio,  the  original  germ  will 
have  over  16,500,000,000  descendants. 

Bacteria  are  children  of  darkness  and  dampness. 
They  are  killed  by  the  sun,  they  are  dried  up 
by  lack  of  water.  Many  are  frozen  to  death. 
Others  are  starved  for  lack  of  proper  food. 
They  may  live  too  crowded,  and  be  killed  by  their 
owTi  poisonous  waste-substances.  When  sub- 
jected to  unfavorable  conditions,  some  tyipes  of 
them  do  not  perish,  but  pass  into  a  resting  or 
''  spore  "  stage,  in  which  state  some  of  them  can 
be  boiled  for  eight  hours  ^vithout  killing  them; 
but  by  boiling  them  on  successive  days,  all  of 
them  can  be  killed,  and  surgical  dressings  and 
equipment  can  be  thus  rendered  positively  free 
from  septic  matter  (i.e.,  made  aseptic,  or  sterile). 

When  the  floor  of  a  great  factory  is  one  immense 
cuspidor,  and  no  radical  efforts  at  sputum  dis- 
posal, nor  effective  ventilation,  is  entertained, 
every  cubic  foot  of  the  atmosphere  inevitably 
contains  many  myriads  more  bacteria  than  is 
present  in  the  atmosphere  out-of-doors.  And 
the  dust  in  buildings  and  factories  that  settles 
ever^nvhere,  likewise,  is  more  than  ordinarily 
infectious. 

Hence  the  necessity  of  the  thorough  cleansing 
of  all  wounds,  and  the  daily  renewal  of  sterile 
dressings  next  to  the  granulating  surface,  until 
full  recovery. 

Hence  the  necessity  of  the  patient  co-operating 


46  ELECTRICAL  INJURIES 

with  the  physician  in  maintaining  the  thorough 
cleanliness  of  the  wound.  It  is  small  display 
of  intelligence  on  the  part  of  a  patient,  who 
deliberately  places  his  unwashed  finger  on  a 
wound,  or  in  proximity  to  a  wound,  made  clean 
by  thorough  washing  on  the  part  of  the  physician. 
Nor  is  it  courteous  to  remove  the  dressings  from 
the  wound,  and  put  on  ''  any  old  thing,"  then 
disparage  the  physician  if  the  results  are  un- 
satisfactory. 

Hence  the  necessity  of  washing  hands  before 
eating. 

Hence  the  necessity  of  a  sufficient  cUetary,  and 
abundant  sleep  to  increase  and  maintain  the 
natural  defenses  of  the  body  against  the  infec- 
tions that  lurk  in  every  confined  atmosphere, 
particularly  against  tuberculosis.  The  constant 
breathing  of  fine  dust  lacerates  the  delicate  lung 
tissues,  and  makes  breaches  through  which  the 
invading  tubercle  l^acilli  more  easily  enter,  and 
more  easily  gain  a  foothold.  The  habitual  use 
of  alcohoUc  liquors  fike\^Hse  impairs  man's  vital 
resistance. 

While  heredity  and  environment  may  act  as 
predisposing  causes  of  disease,  and  while  impaired 
general  health  from  whatever  cause  is  a  con- 
tributing factor,  yet  the  exciting  cause  in  every 
acute  disease  is  some  form  of  pathogenic  bacteria. 

Diseases  of  an  infectious  nature  are  trans- 
mitted   l)y    contact    ^^^th    persons    having    such 


INFECTIONS  47 

diseases,  or  by  using  articles  handled  by  them, 
such  as  towels,  combs,  hair  brushes,  drinking 
cups.  Persons  afflicted  with  an  infectious  disease 
carry  millions  of  these  bacteria.  For  instance, 
persons  having  pulmonary  tuberculosis,  in  an 
active  stage,  are  dangerous  to  the  general  public, 
but  especially  to  those  wdth  whom  they  Uve  and 
work.  Their  expectoration  contains  billions  of 
tubercle  bacilli.  The  sputum  dries  up  and  these 
bacteria  are  spread  broadcast  by  the  wind,  by 
sweeping  and  dusting.  As  bacterial  life  is 
invisible,  we  are  inclined  to  underestimate  these 
micro-organisms;  they  constitute  our  most  for- 
midable enemy;  "  we  are  fighting  an  insidious 
foe." 

By  isolation  and  quarantine,  those  with  in- 
fectious diseases  can  be  separated  from  the 
healthy,  by  methods  of  sanitation  and  disinfec- 
tion the  disease-producing  bacteria  may  be 
eradicated,  and  the  incidence  of  infectious 
diseases  largely  prevented.  But  let  these  bac- 
teria find  lodgment  in  the  human  body,  they 
find  there  the  warmth,  moisture  and  pabulum 
necessary  for  their  existence  and  rapid  propaga- 
tion. Their  host  falls  a  victim  to  a  disease — he 
may  readily  recover  from  it,  or  it  may  result 
fatally.  It  is  a  contest  between  the  host  and  the 
parasitic  invaders. 

Acute  and  subacute  diseases  are  practically 
all   due  to   infections,   and   the  bacteria   (cocci, 


48  ELECTRICAL  INJURIES 

bacilli  and  spirilla)  of  most  of  them  are  well 
understood.  The  conclusion  is  readily  deducible 
that  infectious  diseases  are  preventible;  that 
by  the  isolation  of  those  infected,  until  their 
recovery,  together  with  the  isolation  of  those 
caring  for  them,  the  number  of  persons  exposed 
to  disease  can  be  greatly  reduced,  and  by  the 
intelligent  co-operation  of  all,  the  infectious 
diseases  might  be  made  to  practically  disappear 
from  among  men. 

Tuberculosis  is  acquired  through  the  respira- 
tion; it  can  be  overcome,  when  the  sputum  of 
ever^^bod}^  is  properl}^  disposed  of,  and  when 
every  man  reaches  that  plane  of  devotion  to  the 
public  welfare  that  his  conscience  Tvdll  hurt  him, 
if  he  expectorates  on  any  floor  or  pavement. 
Then  the  great  white  plague  will  have  few  new 
victims. 

Typhoid  fever  and  cholera  are  acquired  through 
the  intestines,  by  drinking  infected  water,  or 
eating  infected  food.  With  an  adequate  suppl}^ 
of  pure  water  in  the  cit}-^  and  on  the  farms,  as 
well  as  all  other  avenues  of  infection  under  con- 
trol, these  and  many  other  preventable  diseases 
give  promise  of  being  successfully  eradicated, 
providing  proper  sanitary  methods  are  con- 
sistently instituted,  and  insistently  maintained. 


THE  EFFECTS  OF  OCCUPATION  ON 
HEALTH  1 

Conservation  of  the  Bodily  Resources — 
Sufficient  Exercise,  Wholesome  Food, 
Abundant  Sleep. 

A  statistical  study  of  the  inroads  of  tuber- 
culosis in  the  tenement  districts  of  Philadelphia 
has  revealed  the  fact  that  the  disease  is  most 
prevalent  among  the  Negroes  and  Italians.  In 
the  Congo  region  of  Central  Africa,  tuberculosis 

^  This  paper  was  originally  presented  before  The  West- 
inghouse  Club  of  Wilkinsburg  (Pittsburgh)  lecture 
season  of  1910.  It  was  pubhshed  in  Physiological 
Thera-peulics,  September,  1911,  It  has  been  enlarged  in 
its  treatment  of  food  and  sleep  at  the  suggestion  of  Mr. 
C.  R.  Dooley,  of  the  Educational  Division,  W.  E.  &  M. 
Co.,  to  enhance  its  value  as  an  article  suitable  specifically 
for  placing  in  the  hands  of  apprentices  of  the  Electric 
Company. 

It  is  so  often  found  that  men  well  informed  on  turbines, 
motors,  generators,  have  been  narrowly  educated  in  the 
Unes  of  their  specialty,  and  that  they  fail  to  apply  their 
knowledge  of  mechanics  and  chemistry  to  that  more 
intricate  machine,  the  human  body.  As  health  is  our 
most  valuable  asset,  and  as  its  complete  possession  is 
essential  to  our  full  efficiency,  the  present  chapter  seems 
opportune. 

49 


50  ELECTRICAL  INJURIES 

is  unknoT\Ti  among  the  Negroes;  in  the  cotton 
fields  of  our  sunny  vSouth  they  are  comparatively 
exempt  from  the  white  plague.  But  transfer 
them  to  Philadelphia,  or  the  slums  of  any  other 
city,  and  they  are  among  its  easiest  victims. 

Similarly,  the  Italians,  spading  and  hoeing 
in  their  gardens  all  the  year  round,  on  the  slopes 
of  Mt.  Vesuvius  or  Mt.  iEtna,  are  comparatively 
exempt  from  tuberculosis.  But  bring  them  to 
our  climatically  inhospitable  shores,  crowd  them 
in  tenements,  underfeed  them,  and  they  become 
victims  of  the  white  plague;  they  succumb  to 
the  invasion  of  the  tubercle  bacillus.  In  both 
cases  the  change  in  occupation  from  outdoor  to 
indoor,  combined  with,  the  change  of  climate,  is 
responsible  for  their  decimation.  The  same  is 
true  of  the  American  Indians.  If  we  allow  indi- 
viduals to  create  the  soil  for  the  infection,  the 
infection  will  find  them. 

Our  American  ancestors  were  pioneers  and 
lived  in  the  forests.  They  were  farmers  and 
lived  in  the  great  out-of-doors.  We  of  the  present 
generation  have  become  urban,  and  the  city  life 
is  a  strenuous  proposition  for  which,  as  a  race, 
we  are  largely  unprepared.  The  problem  is: 
Are  we  becoming  civilized  too  rapidly?  The 
English  nobility  has  divorced  itself  from  manual 
labor  for  several  centuries,  but  has  supplied  the 
need  of  physical  exertion  by  manly  sports — 
riding,  cricket,  polo  and  hockey. 


EFFECTS  OF  OCCUPATION  ON  HEALTH    51 

Exercise 

To  maintain  our  racial  integrity  we  are  under 
the  necessity  of  exerting  ourselves  physically. 
At  present  the  employees  of  American  industrial, 
commercial  and  financial  centers  are  recruited 
from  the  American  farms,  just  as  labor  for  cer- 
tain industries  is  supplied  from  Europe. 

Drawing  the  best  blood  from  the  rural  com- 
munities is  a  bad  thing  for  the  American  farms, 
and  is  not  always  a  good  thing  for  the  American 
farmer  boys,  even  though  they  ^^^n  success  in 
business  and  professional  life  in  the  cities.  In 
this  movement  to  the  cities,  we  must  be  sure  we 
are  not  civilizing  too  rapidly.  Hot  baths,  steam 
heat,  electric  lights,  easy  conditions  of  hfe, 
luxurious  apartments  and  sumptuous  living 
react  on  the  individual. 

There  are  many  in  our  midst  whose  only 
physical  exertion  is  walking  to  and  from  trains, 
yet  who  formerly,  or  occasionally,  performed 
heavy  manual  labor  or  engaged  in  strenuous 
athletics  and  gymnastics.  Those  of  us  who  are 
pursuing  mental  activities  to  our  maximum 
limit,  need  to  take  stock  now  and  then,  and  see 
if  the  balance  is  being  maintained,  if  the  health 
equilibrium  is  assured. 

There  are  500  muscles  on  our  skeletons,  weigh- 
ing nearly  seventy  pounds,  and  only  three  pounds 
of  brain  in  the  human  calvarium;  this  is  adequate 


52  ELECTRICAL  INJURIES 

anatomical  justification  for  manual  occupation 
rather  than  sedentary  office  work.  It  is  this 
preponderance  of  muscles  in  our  bodies  that  makes 
the  ancient  curse  placed  upon  man  a  veritable 
blessing:  "  In  the  sweat  of  thy  face  shalt  thou 
eat  bread."  And  speaking  of  sweating,  there 
is  nothing  more  salutary  for  many  of  us  than 
enough  physical  exertion  to  open  our  pores. 

Physiologists  compute  that  there  are  over 
7,200,000  sweat  glands,  whose  total  length 
amounts  to  over  twenty-eight  miles,  in  the  skin 
of  an  adult  man.  The  elimination  of  waste  by 
the  skin  exceeds  in  weight  the  total  excretion 
from  lungs,  kidneys  and  bowels  combined.  It 
is  apparent  that  adequate  bathing  is  an  essential 
aid  to  assure  proper  skin  elimination.  This 
escape  of  water  and  salts  from  the  skin  is  of 
great  importance,  so  much  so  that  when  perspira- 
tion is  checked,  as  from  deficient  physical  exer- 
tion, it  throws  too  much  work  upon  the  intestinal 
and  respiratory  mucous  membranes.  The  work 
of  elimination  of  waste  products  must  be  attended 
to.  When  the  activity  of  the  skin  is  reduced, 
the  respiratory  and  intestinal  mucous  mem- 
branes act  vicariously  to  maintain  the  elimina- 
tion. By  doing  the  work  of  other  organs  in 
addition  to  their  own  proper  functions,  they  are 
overworked. 

Bearing  in  mind  this  congestive,  hyperemic 
condition  of  the  respiratory  mucous  membranes 


EFFECTS  OF  OCCUPATION  ON  HEALTH    53 

that  ever  exists  among  those  of  us  who  do  too 
little  muscular  labor,  we  can  understand  our 
great  predisposition  to  "  catching  colds."  There 
is  this  constant  liability  to  coryza  {"  cold  "  in 
the  head),  pharj-ngitis  C'  cold  "  in  the  pharynx), 
larjaigitis,  bronchitis,  post-nasal  catarrh,  also 
to  extension  of  the  catarrhal  processes  to  the 
middle  ear  (otitis  media).  Of  course,  "  catch- 
ing cold  "  is  an  infection.  It  is  "  caught  "  as 
measles  or  any  other  infection  is  caught,  yet  the 
predisposing  cause  is  the  congested  condition 
of  the  respiratory  mucous  membranes ;  given  the 
receptive  soil,  the  implantation  of  the  infection 
is  facilitated. 

Similarly,  with  regard  to  disorders  of  the 
stomach  and  intestines,  the  congested  mucous 
membranes  of  the  intestinal  canal  fail  in  the 
digestive  functions  as  a  result  of  their  being 
overworked.  There  is  fermentation  in  the 
stomach;  the  stomach  has  become  a  fermenting 
vat;  there  are  bitter  eructations  (belching),  even 
vomiting  at  times.  There  may  be  a  history  of 
constipation,  alternating  with  diarrhoeal  attacks. 
Yet  all  this  unpleasantness  does  not  constitute 
a  disease,  it  is  merely  a  revolt  of  outraged  nature 
against  artificial  modes  of  living. 

Now,  while  a  resort  to  drugs  is  beneficial  at 
times,  for  relief  from  distressing  symptoms,  and 
the  cure  of  certain  diseases  (medicines  are  indis- 
pensable in  their  place),  yet  when  the  trouble 


54  ELECTRICAL  INJURIES 

is  caused  by  an  inactive  skin,  and  this  by  torpor 
of  the  muscular  system,  the  wise  physician  will 
treat  the  cause;  he  will  instruct  his  patient  to 
shovel  snow,  to  run  a  la^vii  mower,  to  saw  wood, 
or  work  in  a  gymnasium. 

The  starches  we  eat  are  elaborated  into  gly- 
cogen (animal  starch)  in  the  liver,  and  this 
glycogen,  as  potential  muscular  and  heat  energy, 
is  stored  up  in  the  muscles.  It  deranges  metab- 
olism (the  chemical  processes  of  digestion)  to 
have  the  muscular  system  laden  with  unconsumed 
glycogen.  To  those  who  are  familiar  with  the 
chemistry  of  the  hydrocarbons  and  the  proteids 
it  is  necessary  only  to  call  to  your  remembrance 
the  toxic  by-products  of  incomplete  oxidation. 

Much  of  the  dyspepsia  of  sedentary  office  people 
begins  in  the  muscles.  The  incomplete  oxida- 
tion of  foods  already  ingested  (taken  into  the 
body  for  alimentation)  has  so  poisoned  the 
system  that  when  more  food  is  ingested  the 
processes  of  digestion  and  assimilation  are 
imperfectly  performed. 

Without  attempting  to  apologize  for  the  cold 
storage  victuals  that  many  restaurants  and  board- 
ing houses  provide,  and  which  in  themselves  are 
at  times  laden  with  ptomaines,  let  it  not  be  for- 
gotten that  the  neglect  of  ph3^sical  exercise  of 
itself  loads  the  human  organism  with  the  toxins 
of  intestinal  putrefaction,  and  these  toxins, 
together    with    the    toxins    from    the    imperfect 


EFFECTS  OF  OCCUPATION  ON  HEALTH    55 

oxidation  of  glycogen  and  proteid  educts,  can 
conspire  to  upset  our  digestive  processes,  even 
when  the  cook  is  all  right  and  the  grocer  and 
butcher  have  supplied  her  with  fresh  products. 

During  the  years  of  gro\\'th  and  adolescence 
physical  exercise  is  life-giving.  The  farmer  boy 
and  girl  herein  have  an  advantage,  since  the 
physical  stamina  essential  for  the  years  of  stress 
is  largely  acquired  in  early  life.  Moreover, 
^^^thout  attention  to  muscular  work,  grooving 
children  and  sedentary  women  develop  a  liability 
to  various  functional  digestive  derangements, 
and  miscellaneous  reflex  sj^stemic  disturbances. 

For  men  just  out  of  college,  who  have  been 
active  in  football  and  gymnastics,  it  is  especially 
harmful  to  entirely  neglect  all  manner  of  physical 
exercise,  just  as  it  is  so  often  suicidal  for  a 
business  man  or  farmer  to  retire  suddenly  from 
all  mental  and  physical  effort,  to  a  life  of  ease. 

But  why  is  it  harmful?  What  does  it  do  to  the 
athlete?  The  systematic  heavy  exertion  required 
in  athletics  increases  the  size  of  the  heart.  The 
musculature  of  the  heart  enlarges  in  the  number 
of  muscular  fibers,  as  well  as  in  the  size  of  each 
individual  fiber.  The  blood  supply  is  increased 
in  the  new  demands  made  for  the  nutrition  of 
the  greater  bulk  of  its  muscular  elements. 

Now  let  the  athletic  labors  of  the  individual 
suddenly  terminate;  what  will  happen?  There 
is  an  end  to  the  heavy  demands  made  upon  the 


56  ELECTRICAL  INJURIES 

heart,  and  the  heart  atrophies  (diminishes  in 
size).  Its  musculature  is  to  some  degree  replaced 
with  fatty  and  fibrous  elements,  and  its  muscular 
tone  is  impaired.  To  ex-athletes,  and  to  middle- 
aged  men  who  in  their  early  years  did  heavy 
manual  labor,  the  advice  to  continue  physical 
exercise  is  timely.  When  such  persons  contract 
acute  infections,  such  as  pneumonia  or  tj^^hoid 
fever,  they  often  are  the  victims  of  heart  failure. 
Their  mode  of  life  makes  them  more  susceptible 
to  the  invasion;  then  comes  the  pneumococcus 
or  the  typhoid  bacillus  as  the  exciting  cause, 
and  their  damaged  hearts  make  them  easier 
victims  of  the  infection. 

Many  men,  even  before  they  are  thirty,  have 
lived  long  enough  to  know  from  their  own  expe- 
rience that  the  aches  and  pains  wdth  which  they 
wake  up  in  the  mornings,  and  which  have  come 
to  their  joints  and  muscles  when  long  in  one 
position  or  attitude,  will  fade  away  when  they 
exert  themselves  in  the  activities  of  the 
day. 

There  is  much  so-called  rheumatism  that  is 
nothing  more  than  faulty  metabolism,  that  is, 
there  exists  some  perversion  of  chemical  proc- 
esses in  the  human  organism.  Exertion  will 
prove  a  cure  for  grippy  colds  of  this  origin. 
Yet  active,  athletic  exercise  is  harmful  in  the 
incipiency  of  every  acute  disease,  as  diphtheria, 
pneumonia,  etc.     However,  you  have  my  point. 


EFFECTS  OF  OCCUPATION  ON  HEALTH    57 

namely,  that  in  a  selected  group  of  cases,  a 
five-mile  walk  is  the  medicine  required. 

A  case  to  the  point  is  this:  A  certain  over- 
weight, gouty  and  rheumatic  individual  goes 
trout  fishing  when  he  gets  an  attack  of  rheu- 
matism. The  first  few  hours  he  is  out  his  joints 
and  muscles  are  painful  to  him,  but  as  he  shoves 
along  his  corpulent  frame,  now  bathed  in  health- 
giving  perspiration,  he  wades  the  mountain 
streams;  in  the  joy  of  the  chase  he  forgets  that 
his  feet  are  wet,  and  returns  home  after  a  few 
days  with  his  rheumatism  cured. 

Now,  this  being  relatively  true,  what  are  we 
going  to  do  about  it?  Will  we  allow  our  occupa- 
tion to  impair  our  health,  or  will  we  join  the 
"  back  to  the  soil  "  movement?  Will  we  coun- 
teract by  systematic  physical  exercise  the  bane- 
ful effect  upon  our  health  exerted  by  our  several 
occupations,  or  vriW  we  continue  to  neglect  the 
physical  man? 

The  average  tenure  of  life  is  increasing  each 
decade.  Men  in  the  mental  occupations  live 
longer  than  those  who  neglect  the  cultivation 
of  the  mind;  poets,  philosophers,  ministers, 
are  noted  for  longevity,  despite  their  frequent 
neglect  of  physical  exercise.  A  few  weeks  of 
roughing  it  in  the  wilds  will  antidote  the  tedium 
of  many  months  for  the  man  who  is  able  to  relax, 
and  who  maintains  the  stamina  for  some  physical 
exercise. 


58  ELECTRICAL  INJURIES 

Surely,  in  spite  of  our  occupations,  we  can  hope 
to  maintain  the  standard  of  our  health  and 
efficiency  as  we  pursue  our  favored  careers,  if 
we  scrupulously  avoid  dissipation  of  every  type, 
and  live  prudently.  Much  of  the  outcry  against 
unhealthful  occupations  is  due  to  faulty  hygiene, 
improper  diet  and  irregular  hours  of  eating  and 
sleeping.  Our  habitual  health  is  largely  what  we 
make  it.  Excluding  the  deleterious  possibilities 
of  the  dust  and  fumes  incident  to  some  trades, 
and  the  deficient  ventilation  of  most  homes, 
stores,  offices  and  factories,  it  matters  little  what 
our  occupations  may  be.  The  maintenance 
of  our  health  is  largely  in  our  own  hands,  and  our 
physical  salvation  must  be  worked  out  in  con- 
formity with  h3^gienic  laws. 

Food 

A  noted  physiologist,  in  giving  a  definition  of 
life,  has  said  that  life  is  digestion.  All  animal 
and  plant  life  that  cannot  digest  its  appropriate 
food  will  speedily  die,  or  is  already  dead. 

A  man  requires  food  of  three  classes,  namely: 
proteids,  fats  and  carbohydrates. 

Famifiar  examples  of  proteids  are  lean  meats, 
white  of  eggs  and  beans.  Proteids  are  rich  in 
nitrogen,  and  are  the  tissue  builders.  Proteid 
food  is  more  essential  during  the  period  of  grow-th 
than  at  other  periods  of  life,  and  more  required 
by  those  in  laborious  occupations  than  by  others. 


EFFECTS  OF  OCCUPATION  ON  HEALTH    59 

Well-kn(n\ii  fats  are  butter,  lard  and  the  fatty- 
portions  of  meats.  Much  of  the  fat  we  eat  is 
stored  in  the  body  as  potential  energy  for  periods 
of  emergency.  Some  is  used  as  insulation  in 
the  nerve  and  brain  structures.  It  is  also  a 
chief  source  of  muscular  and  brain  energy  and 
heat  production.  It  is  estimated  that  the  fats 
we  eat  furnish  fully  85  per  cent  of  the  energy 
of  our  bodies.  The  fats  of  beef,  pork,  lamb, 
fowls,  indeed  all  the  fat  of  the  meat  should  be 
eaten.  The  extensive  use  of  fats  increases  the 
bodily  resistance  against  infectious  diseases,  and 
likewise  increases  the  physical  and  mental  en- 
durance. When  we  eat  fats  there  is  less  energy 
wasted  than  in  any  other  food  we  consume. 
Starch  globules  and  muscle  fibers  will  be  found 
in  a  microscopic  examination  of  the  excretions 
of  the  bowels  (the  feces),  but  the  fat  we  eat  is 
practically  all  absorbed  and  utilized. 

Carboh^^drates  include  sugars,  starches,  rice, 
tapioca,  and  others.  The  complex  molecule 
of  the  starches  and  sugars  is  broken  into  glucose, 
or  grape  sugar,  and  glycogen,  sometimes  called 
animal  starch.  The  glycogen  is  formed  from 
glucose  and  other  substances,  and  is  stored  in 
the  muscles;  it  is  diminished  in  amount  by 
muscular  activity  and  may  be  made  to  disappear 
altogether,  as  under  electrical  stimulation,  or 
in  an  animal  poisoned  w^th  strychnin. 

We  must  eat  abundantly  of  all  three  types  of 


60  ELECTRICAL  INJURIES 

foodstuffs,  to  maintain  the  wear  and  tear,  fur- 
nish heat,  supply  energy  and  provide  for  growth. 
Dietary  fads  are  always  deplorable.  We  need 
well-cooked  vegetables  to  provide  bulk,  as  pro- 
teids  and  fats  alone  (contained  in  meat  diet) 
are  too  concentrated.  The  Esquimo  eats  strips 
of  blubber  (pure  fat);  we  need  more  fats  and 
starches  in  Tvdnter,  more  fruits  and  vegetables 
in  summer.  The  seasons,  the  climate,  our 
several  occupations,  our  diverse  tastes  and 
preferences,  should  guide  us  in  the  matter  of  our 
diet,  if  our  instincts  have  not  been  irrecoverably 
perverted. 

All  the  vegetables,  nuts,  fruits,  and  cereals 
contain  elements  to  some  extent  necessary  to 
maintain  the  proper  balance  of  the  constituent 
elements  of  the  human  body  in  their  right  pro- 
portion. An  excess  of  any  wholesome  food  may 
bring  satiety,  even  loathing;  on  the  other  hand, 
any  deficiency  of  needed  elements  will  ordinarily 
develop  an  appetite  for  a  certain  article  of  food, 
or  class  of  foods,  which  will  abate  as  the  equilib- 
rium is  again  restored.  The  tissue-balance  is 
best  maintained  by  great  variety  in  diet.  As  is 
well  known,  with  the  advent  of  apples,  potatoes, 
lemons,  such  diseases  as  scurvy  have  disappeared. 

An  elaborate  menu,  with  many  varieties  of 
food  every  meal,  tempting  the  palate  to  excessive 
indulgence,  is  unfortunate.  Habitual  overeat- 
ing is  one  of    the  factors  in  producing  aterio- 


EFFECTS  OF  OCCUPATION  ON  HEALTH    61 

sclerosis  (hardening  of  the  arteries),  that  dread 
precursor  of  premature  old  age.  Less  proteids 
(not  more  than  one  kind  of  meat  at  a  meal), 
more  fruits,  vegetables,  cereals,  will  afford  this 
needed  variety,  and  the  required  bulk,  TV^thout 
inducing  early  degenerative  changes  in  the 
arteries.     '^  A  man  is  as  old  as  his  arteries." 

We  require  much  food  for  maintaining  the  full 
efficiency  of  the  human  machine,  just  as  a  great 
deal  of  fuel  is  required  when  keeping  a  full  head 
of  steam  in  a  boiler.  Some  foods  are  well  bal- 
anced and  supply  all  the  tyi[)es  of  food;  milk  is 
a  perfect  food,  containing  proteid,  fat  and  sugar 
in  nearly  ideal  proportions.  It  is  the  food  for 
the  infancy  of  all  animals  from  the  ant  to  the 
elephant.  Fat  meat  and  potatoes  is  a  perfect 
combination;  so  is  bread  and  butter  and  eggs; 
and  similarly  macaroni,  butter  and  cheese 
combine  admirably.  In  fact,  we  are  quite 
scientific  in  most  of  our  dietary  combinations 
without  expending  much  thought  about  it,  if 
only  our  normal  healthy  appetites  remain  un- 
perverted. 

When  food  has  been  taken  into  our  stomach 
we  say  it  has  been  ingested;  when  it  has  been 
carried  off  from  the  stomach  into  the  intestines, 
acted  upon  by  the  digestive  juices  and  ferments 
and  liquefied  for  its  absorption,  it  is  said  to  be 
digested;  when  it  has  been  carried  off  by  the 
blood  and  lymph  vessels,  ready  for  appropriation 


62  ELECTRICAL  INJURIES 

by  the  cells  forming  the  various  organs  and 
tissues  of  our  bodies,  then  the  food  has  been 
assimilated.  These  chemical  processes,  in  split- 
ting up  food  elements  and  recombining  them  into 
suitable  compounds,  and  the  oxidation  processes 
by  which  we  derive  our  energy  and  heat  are 
collectivel}^  known  as  metabolism.  Metabolism 
may  also  be  defined  as  the  power  possessed  by 
animal  and  plant  life,  that  enables  it  to  use  up 
new  material  (constructive  metabolism)  and 
that  enables  it  to  throw  off  effete  material 
(destructive  metabolism),  enabling  the  living 
body  to  grow,  and  to  renew  and  prolong  its  hfe, 
by  molecular  changes  constantly  taking  place 
in  the  condition  of  its  cehs. 

The  close  analogy  between  the  steam  engine 
and  the  human  machine  is  familiar  to  all.  In 
the  transformation  of  energy  the  human  machine 
is  much  more  efficient.  The  steam  engine  de- 
pends upon  the  burning  of  coal  (oxidation)  for 
the  development  of  its  heat  and  energy.  The 
human  machine  requires  foodstuffs.  In  both 
there  is  no  production,  simply  a  transformation 
of  energy.  The  potential  energy  of  the  coal  was 
stored  up  bj^  the  sun  in  primeval  vegetation 
millions  of  years  ago,  to  be  set  free  by  the  burning 
of  the  coal.  The  potential  energy  of  our  foods, 
directly  or  indirectl}^  of  vegetable  origin,  has 
been  stored  up  by  the  sun,  and  is  released  by 
oxidation  at  low  temperature  (under  100°  F.)  in 


EFFECTS  OF  OCCUPATION  ON  HEALTH   63 

our  tissues.  The  products  are  moreover  similar 
whether  the  food  is  slowly  burned  in  the  muscles 
and  other  tissues  of  the  body,  or  rapidly  burned 
in  the  fire  of  a  furnace,  except  in  the  case  of 
proteids  (nitrogenous  substances),  which  are 
less  completely  burned  up  in  the  body,  the  nitro- 
gen being  given  off  in  the  form  of  urea  and  re- 
lated bodies.  In  the  furnace  this  urea  can  be 
further  oxidized  into  nitrogen  gas,  carbon  dioxide, 
and  water.  Fats,  sugars  and  starches  are  com- 
pletely burned  up  (oxidized)  in  the  human  body; 
their  end-products  are  water  and  carbon  dioxide. 
Such  chemical  changes,  as  stated  before,  con- 
stitute one  phase  of  metabolism. 

The  carbon  dioxide  we  eliminate  with  our 
expired  air;  the  water,  urea,  many  inorganic 
salts  and  certain  other  products  are  excreted 
by  the  kidneys.  The  feces  contain  the  unap- 
propriated food,  and  miscellaneous  effete  sub- 
stances. Water,  certain  salts  and  ethereal  bodies 
escape  by  the  skin. 

Fatigue 

Fatigue  is  largely  due  to  an  accumulation  of 
the  waste  substances  produced  by  muscular 
activity.  The  fatigue  subsides  when  a  period 
of  rest  intervenes,  permitting  of  the  excretion  and 
elimination  of  these  waste  substances.  The 
true  restoratives  for  fatigue  are  found  in  pure 


64  ELECTRICAL  INJURIES 

water  and  wholesome  food,  rather  than  in  drugs 
and  alcoholic  beverages.  Training  to  a  great 
degree  reheves  fatigue;  work  and  exertion 
become  easier,  through  the  accustoming  of  the 
heart  and  respiratory  centers  to  greater  quan- 
tities of  fatigue  products.  Through  improve- 
ment in  our  muscles  by  increasing  their  bulk, 
strength  and  dexterity,  our  exertions  produce 
a  diminished  quantity  of  the  waste  products  of 
fatigue.  And  simultaneously  there  is  evolved 
an  increased  capacity  of  the  heart  for  handling 
the  greater  blood  stream  and  of  the  lungs  for 
eliminating  the  increased  carbon  dioxide;  there 
is  effected  a  general  improvement  in  the  other 
avenues  of  elimination  of  the  waste  substances 
due  to  fatigue,  namely,  the  skin,  the  intestines 
and  the  kidneys. 

That  there  is  a  definite  production  of  such 
waste  substances,  and  that  these  waste  sub- 
stances of  fatigue  accumulate  more  rapidly 
than  they  can  be  removed,  is  capable  of  phys- 
iological proof.  A  dog  is  thoroughly  tired  out 
by  running.  The  blood  of  the  tired  dog  is  now 
injected  into  the  veins  of  a  perfectly  rested  dog, 
when  the  latter  exhibits  all  the  symptoms  of 
fatigue. 

Similarly,  the  massage  of  fatigued  muscles, 
kneading  out  of  the  muscular  fibers  into  the 
blood  and  lymph  channels  this  excess  of  waste 
products,  lessens  the  sense  of  fatigue.     The  flow 


EFFECTS  OF  OCCUPATION  ON  HEALTH    65 

of  a  properly  selected  electric  current  will  like- 
wise relieve  fatigue. 

In  order  to  maintain  our  efficiency,  we  more- 
over require  some  relaxation  and  recreation,  but 
above  all  we  need  long  hours  of  sleep. 

Sleep 

Sleep  is  a  reparative,  recuperative  process; 
it  is  produced  by  the  benumbing  effects  of  the 
waste  products  of  activity  upon  the  cells  of  those 
areas  of  the  brain-cortex  that  preside  over  the 
senses.  Sleep  is  also  invited  by  excluding  sensory 
stimuli,  especially  light  and  sound.  By  sleeping 
in  a  cool  well-ventilated  room,  on  a  firm  mattress, 
adequately  covered,  but  not  excessively  weighted 
with  bed  clothing,  sleep  is  favored.  A  mod- 
erately hot  bath  before  retiring  is  found  by  many 
to  promote  sleep,  as  does  eating  in  moderation 
before  retiring;  the  gnawing  of  a  hungry  stomach 
drives  away  sleep.  Furthermore,  one  of  the 
best  methods  of  depleting  the  blood  vessels  of 
the  brain  is  to  divert  the  blood  current  to  the 
abdomen  by  means  of  food.  Other  modes  of 
equalizing  the  circulation  suggest  themselves. 
If  there  has  been  too  little  physical  exertion,  a 
short  walk  in  the  open  air,  or  light  gymnastics, 
yet  avoiding  excessive  fatigue,  promotes  sleep. 
A  person  can  be  too  exhausted  to  sleep  well ;  over- 
exertion and  under-exertion  are  alike  inimical 


66  ELECTRICAL  INJURIES 

to  sleep.  Changing  during  the  evening  from  a 
heavy  study  to  light  literature,  or  to  games  and 
other  diversions,  may  be  conducive  to  sleep.  A 
personal  study  of  one's  individual  case  is  alwaj^s 
preferable  to  an  habitual  resort  to  hypnotic 
drugs.  We  cannot  always  sleep  instantly  on 
retiring;  there  is  vasomotor  relaxation  during 
such  rest  in  bed  that  is  nearly  as  refreshing  as 
sleep.  Deep  regular  breathing  upon  retiring 
assists  some  persons  in  getting  to  sleep.  In  sleep 
there  is  a  diminished  rate  of  respiration,  the 
heart  beats  about  eight  times  less  each  minute, 
and  the  blood  pressure  in  the  brain  is  lowered. 
Sleep  is  nature's  sweet  restorer,  but  to  be  per- 
fect, no  sensory  impulses  should  reach  the  higher 
brain  centers;  the  activities  of  the  day  likewise 
must  be  dismissed  from  consciousness,  the 
planning  and  the  troubles  of  the  present,  past  and 
future,  should  not  be  reviewed  when  we  recline 
upon  our  couches  at  the  end  of  the  day. 

Ordinary  pains  and  aches,  as  neuralgia  and 
toothache,  even  injuries,  as  contusions,  or  a 
foreign  body  in  the  eye,  are  reported  merely  to 
subconsciousness  while  the  mind  is  alert  and  the 
body  tuned  up  to  its  full  measure  of  activity, 
during  the  busy  hours  of  the  day.  When  we 
retire  for  sleep,  and  relax  every  fiber  of  our 
bodies,  and  disassociate  every  line  of  thought, 
and  free  ourselves  from  sense  stimuli  (as  noise 
and  light)  as  much  as  possible,  then  these  sub- 


EFFECTS  OF  OCCUPATION  ON  HEALTH    67 

conscious  states  may  emerge  to  the  field  of  con- 
sciousness, and  exert  a  disquieting  influence, 
destructive  to  sleep.  These  sensations  are  admo- 
nitions, and  warn  us  of  defects  and  functional 
derangements  that  require  attention.  The  cause 
must  be  found  and  removed.  The  dentist,  the 
surgeon,  the  physician  may  be  advantageously 
consulted.  "  Make  your  repairs  before  the 
machine  breaks  down." 

Physical  and  mental  states  may  be  conducive 
to  sleep,  yet  introspective  analysis  of  life  and 
conduct  may  destroy  sleep.  Without  entering 
the  realm  of  the  metaphj^sical,  it  is  nevertheless 
proper  to  mention  in  this  connection  that  integrity 
of  hfe,  honor,  honesty,  virtue,  purity,  "  a  con- 
science void  of  offense,"  ability  to  look  the  whole 
world  in  the  face,  induces  an  equanimity  favorable 
to  sleep,  and,  despite  fleeting  years,  helps  main- 
tain the  vigor  of  youth  to  a  ripe  age. 

A  normal,  healthy  man  in  a  quiet  room  will 
ordinarily  sleep  eight  hours.  Regular  hours  of 
sleep  are  highly  desirable.  The  night  is  the 
proper  time  for  sleep.  As  the  number  of  hours 
of  sleep  required  in  advancing  life  varies  with 
each  individual,  the  determination  of  how  many 
hours  are  essential  to  each  of  us  must  remain  a 
personal  matter.  Yet  seven  hours  in  bed  is  too 
little  for  many  brain  and  muscle  workers.  Dur- 
ing the  years  of  their  rapid  growth,  children 
require  much  more  sleep;    they  eat  proportion- 


68  ELECTEICAL  INJURIES 

ately  more  than  adults,  and  as  they  do  not 
appropriate  in  tissue-building  nearly  all  the  food 
they  assimilate,  they  too  have  waste  products 
to  eliminate.  During  natural  sleep  such  elim- 
ination is  much  facilitated.  Sleep  is  more  re- 
freshing when  there  is  an  abundance  of  fresh  air 
in  the  sleeping  apartments.  Windows  are  made 
to  be  opened.  During  the  day  our  activities 
carry  us  in  and  out,  and  we  get  much  fresh  air, 
but  at  night  especially  we  need  an  abundance 
of  fresh  air,  air  rich  in  oxygen,  in  our  bedrooms. 
This  assures  to  the  wearied  brain  and  tired  body 
refreshing  sleep,  and  provides  for  the  blood, 
unpoverished  by  the  clay's  exertions,  sufficient 
oxygen  to  maintain  the  haemoglobin  (the  iron- 
containing  proteid  of  the  red  corpuscles)  at  the 
full  100  per  cent  standard  of  health.  Thus  can 
we  hope,  in  spite  of  our  occupations,  to  counteract 
their  deleterious  tendencies;  and  we  can  maintain 
such  a  degree  of  health  as  will  enable  us  to  resist 
infections,  and  can  maintain  that  degree  of 
buoyancy  and  resiliency  that  will  make  life  a 
joy  and  our  routine  duties  a  pleasure. 


QUESTIONS  ON  ELECTRICAL  INJURIES^ 

1.  What  is  meant  by  an  electrical  flash? 

2.  What  is  the  effect  of  a  flash  on  the  eyes? 

3.  What  is  the  effect  of  a  flash  on  the  skin? 

4.  What  is  likely  to  occur  in  opening  a  switch  carry- 
ing a  heavy  current  of  electricity? 

5.  Can  a  flash  injury  occur  without  the  person  com- 
ing in  immediate  contact  with  an  electric  current? 

6.  Why  does  a  person  very  seldom  make  contact 
with  a  circuit  of  15,000  volts  or  over? 

7.  What  parts  of  the  body  are  most  usuaUy  affected 
by  an  electrical  discharge? 

8.  What  is  the  extent  of  injury  in  a  second  degree 
burn? 

9.  What  is  a  third  degree  burn? 

10.  What  precaution  should  be  taken  when  working 
around,  or  looking  at  an  electric  welding  machine  in 
operation? 

11.  Can  a  burn  from  an  electric  arc  occur  when  the 
person  is  too  far  away  to  feel  any  heat? 

12.  How  long  a  time  may  elapse  before  an  electric 
burn  becomes  noticeable? 

1  The  author  tenders  special  acknowledgements  to  R.J. 
Watson,  of  the  Casino  Technical  Night  School,  for  assist- 
ance in  compiling  the  ensuing  questions. 

69 


70  ELECTKICAL  INJURIES 

13.  What  is  conjunctivitis?  What  is  the  best  single 
remedy  in  its  treatment? 

14.  What  is  the  first  consideration  in  the  treatment 
of  everj'  electrical  burn? 

15.  What  is  infection? 

16.  What  is  the  cause  and  what  are  the  symptoms 
of  infection? 

17.  What  dressings  should  a  burn  receive  after  it 
has  been  thoroughly  cleansed? 

18.  Should  blebs  or  water  blisters  be  opened?  Why? 

19.  Describe  the  effect  of  a  flash  from  high  voltages? 

20.  What  are  the  visible  marks  of  a  high  voltage 
flash? 

21.  Is  fright  ever  a  fatal  factor  to  a  person  receiving 
an  electrical  shock? 

22.  What  amperage  of  current  is  used  in  criminal 
electrocutions? 

23.  Which  is  the  better  conductor,  oil  or  salt  water? 

24.  Which  is  the  better  conductor  of  electricity, 
nerve  tissue  or  the  blood?  Wh}^? 

25.  Describe  the  effect  of  a  heavj^  electric  current 
on  the  following  organs  as  determined  by  post-mortem 
examination  at  criminal  executions — heart,  lungs, 
nerves,  capillaries,  blood  and  muscles. 

26.  What  is  the  color  of  the  blood  when  death  has 
been  caused  by  an  electrical  shock?   Why? 

27.  Does  the  blood  coagulate  when  death  has  been 
produced  by  electrical  shock?  Why? 

28.  What  is  metabohsm? 

29.  What  is  asphyxiation? 

30.  What  is  anaemia? 

31.  Describe  the  three  theories  advanced  regarding 
death  due  to  electrical  shock. 


QUESTIONS  ON  ELECTRICAL  INJURIES     71 

32.  What  precautions  should  be  taken  by  the  per- 
son or  persons  who  go  to  the  rescue  of  one  who  has 
received  an  electrical  shock? 

33.  What  is  resuscitation? 

34.  What  is  the  first  thing  to  be  done  after  the  patient 
has  been  released  from  the  electrical  contact? 

35.  In  what  position  should  the  patient  be  laid? 

36.  What  position  should  the  operator  assume? 

37.  Describe  the  motions  to  be  performed  by  the 
operator? 

38.  What  should  be  the  length  of  time  in  making  the 
dowTiward  pressure? 

39.  What  part  of  the  patient's  body  should  receive 
the  weight  of  the  operator? 

40.  What  part  of  the  hand  of  the  operator  should 
press  on  the  patient? 

41.  Should  the  operator's  arms  be  rigid  and  straight 
or  should  they  be  bent  and  flexible? 

42.  How  rapidly  should  the  operator  work? 

43.  How  long  should  work  be  continued  on  patient 
before  concluding  that  life  is  extinct? 

44.  Who  should  determine  whether  or  not  con- 
tinued effort  at  resuscitation  would  be  futile? 

45.  Should  the  patient  be  given  any  hquid  stimulant 
before  breathing  has  been  established? 

46.  What  would  you  give,  by  inhalation,  as  a  stim- 
ulant to  breathing? 

47.  What  assistance  can  be  rendered  by  the  person 
or  persons  assisting  the  operator? 

48.  How  soon  should  the  patient  sit  up  after  regain- 
ing consciousness? 

49.  Name  five  specific  advantages  of  using  the 
Prone  Pressure  method  of  resuscitation. 


72  ELECTRICAL  INJURIES 

50.  What  are  the  disadvantages  of  laying  the  patient 
on  his  back  during  efforts  at  resuscitation. 

51.  What  is  the  average  resistance  of  the  human  skin? 

52.  What  will  increase  this  skin  resistance? 

53.  What  factors  will  lower  this  skin  resistance? 

54.  Under  what  circumstances  may  110  volts  be 
dangerous? 

55.  Do  the  number  and  location  of  the  points  of 
contact  increase  the  danger  from  the  passage  of  the 
current? 

56.  What  amperage  is  dangerous? 

57.  Why  does  the  victim  usually  receive  merely  a 
leakage  current  and  not  the  full  voltage  of  the  line? 

58.  What  are  the  causal  factors  in  dangerous 
electrical  shocks? 

59.  Contact  burns  are  usually  of  what  degree? 

60.  AVhy  should  all  electrical  burns  receive  medical 
attention  at  once. 

61.  What  is  gangrene? 

62.  What  is  necrosis? 

63.  Is  gangrene  or  necrosis  ever  the  result  of  an 
electrical  burn? 

64.  Why  is  amputation  sometimes  necessary  when 
the  burn  appears  trivial  at  first? 

65.  Does  artificial  respiration  save  life? 

66.  What  is  the  usual  behavior  of  persons  witnessing 
an  electrical  shock? 

67.  What  should  be  the  actions  of  those  witnessing 
an  electrical  shock? 

68.  Is  ignorance  ever  criminal  negligence? 

69.  What  various  means  can  be  employed  in  rescu- 
ing a  comrade  from  a  high-voltage  circuit  without 
endangering  the  rescuer? 


QUESTIONS  ON  MINOR  SURGERY 

1 .  What  is  the  difference  between  an  incised  wound, 
a  lacerated  wound  and  a  puncture  wound? 

2.  What  are  the  first  signs  that  a  wound  has  become 
infected? 

3.  What  simple  treatment  should  be  given  a  small 
wound  to  insure  it  against  infection? 

4.  In  case  muscles,  tendons  or  nerves  are  cut  through, 
how  is  complete  recovery  of  function  secured? 

5.  How  are  surgical  dressings  made  aseptic? 

6.  What  do  j^ou  mean  by  aseptic? 

7.  If  blood  is  flowing  from  a  wound  in  what  two  ways 
could  you  distinguish  whether  the  hemorrhage  is 
arterial  or  venous? 

8.  If  the  wound  is  bleeding  in  spurts,  where  would 
you  apply  the  bandage? 

9.  What  is  a  fracture? 

10.  What  is  a  compound  fracture? 

11.  W^hat  is  the  best  way  to  restore  a  fainting  person? 

73 


QUESTIONS  ON  INFECTION 

1.  What  is  wound  infection? 

2.  What  is  an  infectious  disease? 

3.  W^hat  are  bacteria? 

4.  Are  they  all  injurious  to  man? 

5.  Are    they    classed    as    animal    or    as    vegetable 
micro-organisms? 

6.  Under  what  conditions  are  bacteria  most  readily 
developed? 

7.  How  may  bacteria  be  killed? 

8.  Does  spitting  on  the  floor  or  sidewalk  endanger 
health,  and  why? 

9.  Why  should  the  hands  be  washed  before  eating? 

10.  What    effect    does    an    insufficient    amount    of 
sleep  and  food  have  upon  the  body? 

11.  What  are  predisposing  causes  of  disease?   What 
io  the  exciting  cause? 

12.  What  is  tuberculosis  and  how  is  it  acquired? 

13.  What   are   some   of   the   precautions   taken  to 
avoid  infection  by  tuberculosis? 

14.  What  are  some  of  the  ways  in  which  infectious 
diseases  are  spread? 

15.  How  are  typhoid  fever  and  cholera  acquired? 

16.  How  can  infectious  diseases  be  eradicated? 

74 


QUESTIONS  ON  HEALTH  AND 
OCCUPATION 

1.  Does  the  occupation  have  any  determining 
effect  upon  the  health  of  the  individual? 

2.  Whj^  is  the  present  generation  subject  in  a  greater 
degree  to  tuberculosis  than  their  ancestors? 

3.  Why  should  a  definite  part  of  the  day  be  given  to 
physical  exercise,  especially  on  the  part  of  those  in 
sedentary  occupations? 

4.  What  are  the  beneficial  results  to  be  derived  from 
perspiring  freely? 

5.  Does  the  skin  carry  off  any  waste  matter? 

6.  What  is  the  effect  on  the  other  organs  when  the 
skin  does  not  perform  its  proper  function? 

7.  Is  a  "  cold  in  the  head  "  contagious? 

8.  Why  do  we  "  catch  cold  "  ? 

9.  What  predisposes  us  to  "  catcliing  cold  "  ? 

10.  Is  a  resort  to  drugs  necessary  every  time  we 
feel  out  of  condition? 

11.  Should  a  man  be  his  own  physician? 

12.  In  what  way  does  deficient  exercise  disturb 
our  digestion  and  assimilation? 

13.  Why  is  a  business  man's  or  a  farmer's  life  often 
shortened  by  retiring  from  active  business? 

14.  How^  do  athletics  develop  the  heart?  Does 
heav3'  labor  in  early  life  tend  to  longevity? 

15.  The  outcrj^  against  unhealthful  occupations 
should  as  a  rule  be  charged  to  what? 

75 


76  ELECTRICAL  INJURIES 

16.  Name  the  three  classes  of  foods  required  by  the 
human  body. 

17.  Name  some  of  the  proteids. 

18.  What  purpose  do  they  serve? 

19.  In  what  period  of  Hfe  are  proteids  most  needed? 

20.  What  is  the  use  of  fat  to  the  human  body? 

21.  Name  some  of  the  carbohydrates. 

22.  What  purposes  do  they  serve? 

23.  Why  is  variety  in  diet  advantageous? 

24.  What  is  the  best  guide  to  our  diet? 

25.  In  what  way  does  over-eating  prove  injurious? 

26.  What  is  ingestion? 

27.  What  is  digestion? 

28.  What  is  assimilation? 

29.  What  is  metabolism? 

30.  What  is  oxidation? 

31.  Name  the  chief  end  products  of  complete  oxida- 
tion. 

32.  Is  there  any  difference  between  the  fuel  con- 
sumed in  a  steam  engine  and  the  food  consumed  in 
the  body?  Trace  the  analogy. 

33.  What  is  the  function  of  the  kidneys? 

34.  What  is  the  cause  of  fatigue? 

35.  In  what  three  ways  does  training  diminish 
fatigue? 

36.  What  is  the  best  cure  for  fatigue? 

37.  What  is  elimination? 

38.  What  is  rest?   Is  inactivity  rest? 

39.  What  proofs  have  we  that  fatigue  products 
accumulate  in  the  body? 

40.  What  is  sleep? 

41.  What  produces  sleep? 

42.  Of  what  use  is  sleep? 


QUESTIONS  ON  HEALTH  AND  OCCUPATION   77 

43.  Do  all  persons  need  the  same  amount  of  sleep? 

44.  How  many  hours  of  sleep  are  needed  by  the 
normal  man? 

45.  Should  a  person  go  to  bed  hungry? 

46.  Enumerate    six    factors   conducive    to    natural 
sleep. 

47.  Under  what  conditions  is  sleep  most  favorable? 

48.  Why  do  children  require  more  sleep  than  adults? 

49.  Does  regularity  of  habits  have  anything  to  do 
with  the  general  health  of  the  individual? 


^O  \,_A^ 


UNIVERSITY  OF  CAi 
BERIv 

Return  to  desk  fr^ 
This  book  is  DUE  on  tl 

ENGINE 


APR  1  3  1948 

APR  2  7  1348 


LD  21-100m-9,'47(A5702sl6)476 


YA  0X95 


.,'->; 


257831 


•eeriDi? 


